Findings from both cross-sectional and prospective studies appear to support this notion by consistently showing a heightened risk of morbidity and premature death associated with the development of micro- and macro-vascular disease from the combination of smoking and diabetes. There is evidence that smoking increases the risk of coronary artery disease in type 2 diabetes (5,6). For example, in a prospective cohort of 7,401 female nurses with type 2 diabetes, cigarette smoking was found to be strongly associated with the risk of coronary heart disease (CHD) and this risk increased with the number of cigarettes smoked per day (7). Based on data from 4,540 patients with type 2 diabetes followed in the UK Prospective Diabetes Study (UKPDS), smoking was shown to increase the risk of coronary heart disease in both males and females with type 2 diabetes. The estimated Risk Rate (RR) occurrence of a fatal or non-fatal MI or sudden death attributable to smoking was 1.35 (8). Smoking also increases the risk of stroke (9). Based on patients with type 2 diabetes enrolled in the UKPDS, mathematical models including major confounding variables (including age, sex, atrial fibrillation, etc) estimated that a non-smoking male with a current age of 67 years would have a 6.9% probability of a stroke within 5 years compared with a 10.5% probability for a smoking male of the same age (10). Moreover, several studies have shown that smoking promotes the onset and progression of nephropathy in type 2 diabetes (11-13). In a logistic regression analysis examining associations between gender, age, stage of nephropathy, smoking status, cigarette pack-years, hypertension, total cholesterol, triglycerides, Glycated hemoglobin (HbA1c), and Blood pressure (BP), current and former smoking (P = 0.0012) and number of pack-years (P = 0.011) were shown to be the greatest predictors of the progression of nephropathy (12). Smoking has also been shown to exacerbate markers of kidney failure in this population, such as microalbuminuria (14). In addition, stopping smoking has been shown to reduce the progressive damage to the kidneys in comparison with continued smoking in type 2 diabetes (14).