Background: To study the effects of cadmium chloride (CdCl2) combined with hSmac on the proliferation and apoptosis of hepatocellular carcinoma cells, i.e. SMMC-7721. Methods: SMMC-7721 cells were transfected with pcDNA3.1+-hSmac using a lipofectamine-mediated method, and then cell viability was detected by MTT assay after exposure to 10, 20, and 30 µmol/l CdCl2. Apoptosis was determined by both acridine orange-ethidium bromide staining and flow cytometry, and expressions of caspase-3, caspase-9, and cytochrome c by Western blot. Results: CdCl2 had cytotoxicity to SMMC-7721 cells, and it could inhibit proliferation in a dose-dependent manner and induce apoptosis; hSmac could inhibit proliferation and induce apoptosis independently in SMMC-7721 cells. Furthermore, cotreatment with CdCl2 and hSmac could enhance antiproliferative and proapoptotic effects in SMMC-7721 cells. Conclusions: hSmac could enhance the cytotoxicity of CdCl2.