Tobacco consumption (predominantly cigarettes) is the leading preventable cause of mortality worldwide. While the major focus of strategies to reduce mortality from tobacco must include prevention of future generations from initially gaining access, some smokers are unwilling/ unable to quit. Can the higher risk chronic smoker be identified and can their risk be reduced?The risk of adverse events in cigarette smokers is influenced by the intensity/duration of cigarette smoking or second hand exposure, associated conventional risk factors, environmental stressors and certain genetic variants and epigenetic modifiers.