People who smoke have characteristic facial changes similar to those seen in premature aging.1 Grey hair, facial wrinkles, and smoking are also established risk factors for myocardial infarction.2 Although greying and hair loss are natural phenomena that affect us all, one of us (JGM) had often met patients in his clinic aged under 50 who not only seemed to have more severe arterial disease than one would expect but also looked older than their chronological age, and he had noticed that most of these patients seemed to smoke. This study was designed to test the hypothesis that premature hair change may be causally associated with cigarette smoking.