BACKGROUND: Data regarding the impact of cigarette smoking on trace elements are scarce and inconsistent. In this study, we evaluated the effect of smoking on serum concentrations of trace elements among adult males with heart disease. METHODS: This cross-sectional study included 100 adults hospitalized with heart disease in Bangladesh. The major variables of interest included mean serum concentrations of trace elements and proportion of subjects with bacterial growth on throat swab culture. RESULTS: Smokers had significantly lower serum concentrations of retinol, alpha-tocopherol, selenium, and zinc and increased concentrations of copper. Throat swab cultures were more often positive for Streptococcus beta-hemolyticus in smokers than controls. CONCLUSIONS: Smoking decreases serum concentrations of trace elements. Smoking control programs are needed in Bangladesh to improve health and nutrition of the people who are already nutritionally deficient.