Background <p>The high smoking prevalence and growing burden of chronic metabolic diseases have been threatening public health in Northeast China. This study aimed to investigate the association of smoking/quitting status with hypertension, diabetes, and dyslipidemia in residents in Northeast China.</p> Methods <p>A total of 78,674 adults aged 35–75 years old were enrolled from a cross-sectional study conducted in Northeast China in 2020. Demographic data were collected, and biochemical indices and anthropometric indices were measured. Associations of smoking/quitting status with hypertension, diabetes, and dyslipidemia were investigated using logistic regression. Restricted cubic spline analysis was performed to assess the dose-response relationship between smoking/quitting status and prevalence of dyslipidemia, diabetes, and hypertension.</p> Results <p>A total of 16,401 (20.85%) smokers, 25,805 (32.80%) adults with dyslipidemia, 16,812 (21.37%) adults with diabetes, and 33,539 (42.63%) adults with hypertension were identified in this study. The risk of diabetes, dyslipidemia, and hypertension in current heavy smokers and former heavy smokers were higher than that in never-smokers (all <i>P</i> &lt; 0.001). The risk of dyslipidemia, diabetes, and hypertension elevated with the increase of cigarette amounts from “1–5 cigarettes per day” to “≥31 cigarettes per day” and smoking duration from “1–18 years” to “19–31 years”. However, excluding quitting smoking for 2–3 years (OR = 1.30, 95% CI: 1.01–1.67, <i>P</i> = 0.041) and 7–20 years (OR = 1.43, 95% CI: 1.12–1.83, <i>P</i> = 0.004) enhancing diabetes risk, quitting duration was not associated with the risk of dyslipidemia, diabetes, and hypertension (all <i>P</i> &gt; 0.05).</p> Conclusion <p>Smoking status, smoking amount, and smoking duration, rather than quitting duration, are associated with the risk of dyslipidemia, diabetes, and hypertension among adults in Northeast China.</p>