Modifiable cardiovascular risk factors commonly include disorders of lipid metabolism, arterial hypertension, smoking, alcohol consumption, physical inactivity, overweight, etc. The number of epidemiological studies have already proved the presence of the associations between them and the risk of developing cardiovascular diseases. However, the analysis of the recent studies showed that despite the negative impact of these factors on cardiovascular health, there are some arguments that prove their positive effects. Such a phenomenon is commonly described in the publications as a “paradox” of a particular risk factor. This review presents data on the smoking paradox – one of the leading risk factors contributing to the development of cardiovascular diseases.