['Emerging data suggests that the combination of smoking and metabolic syndrome (MetS) markedly increases cardiovascular disease risk well beyond that of either condition. In this study we assess if this interaction can be explained by an additive increase in the risk of systemic inflammation by MetS and cigarette smoking.', 'We evaluated 5,503 healthy non-diabetic Brazilian subjects (mean age of 43\u2009±\u200910\xa0years, 79% males). Participants were divided into sub-groups of smokers and non-smokers with or without MetS. High-sensitivity C reactive protein (hs-CRP) was measured to assess degree of underlying inflammation.', 'Overall (19%) had hs-CRP\u2009>\u20093\xa0mg/L. In adjusted regression analyses, compared to non-smokers, there was a 0.19\xa0mg/L (95% CI: 0.05, 0.32) increase in hs-CRP among smokers in the entire population and 0.63\xa0mg/L (95% CI: 0.26, 1.01) increase among smokers with MetS while there was no significant increase among smokers without MetS (β\u2009=\u20090.09 95% CI: -0.05, 0.24). In a fully adjusted logistic regression model, smokers compared to non-smokers were 55% more likely to have elevated hs-CRP in the entire population (OR 1.55, 95% CI: 1.25, 1.92) and more than twice as likely to have elevated hs-CRP if they had MetS ( OR 2.05, 95% CI: 1.40, 3.01) while the risk was non-significant among those without MetS (OR\u2009=\u20091.29, 95% CI: 0.98, 1.69).'] Does cigarette smoking worsen systemic inflammation in persons with metabolic syndrome?