The relationship of cigarette smoking with blood pressure and serum lipids and lipoproteins was studied in the 3934 middle-aged women aged 40 to 59 years. After adjusting age, body mass index (BMI), alcohol intake and physical activity scores, the mean systolic and diastolic blood pressures (SBP and DEP, respectively) did not indicate dose-dependent relationships. The largest significant mean differences in SBP (4.6 mmHg), DBP (3.9 mmHg), high density lipoprotein cholesterol (HDL-C) (9.6 mg/dL), ratio of total cholesterol to HDL-C (TC/HDL-C) (0.8), triglycerides (TG) (22.9 mg/dL) and the logarithmic transformation of TG (Log TG) (0.26) were found between the non-smokers and smokers. When age, BMI, alcohol intake and physical activity scores were included in the forward stepwise multiple regression analyses, there were negative relationships found for cigarette smoking and SBP, DBP and HDL-C and positive relationships for cigarette smoking and TC/HDL-C, TG, Log TG and low density lipoprotein cholesterol. Although the results are somewhat variable, the present study shows cigarette smoking is negatively associated with SBP and DBP and unfavorably associated with serum lipids and lipoproteins in middle-aged women.