Objective: To determine the frequency of hypercholesterolemia in patients who are diagnosed with acute coronary syndrome and to also document the association of Non HDL-C with Acute coronary syndrome in these patients. Study Design: Observational Cross Sectional study. Setting: Department of Cardiology and Pathology of Sheikh Zayed Hospital, Rahim Yar Khan. Period: September 2019 to February 2020. Material & Methods: One hundred and thirty five patients with Acute coronary syndrome were included using non probability purposive sampling technique and equal number of patient who visited the outpatient department or admitted in indoor with complaints other than ACS were taken as control (n=135). Frequency and percentages were calculated and odd ratio was determined to see the association. Statistical significance was set at P-value<0.05. Results: Patient’s mean age was 55.5±12.4 years and there were 98(73%) male and 37(27%) female. Higher Non HDL-C (>130mg/dl) was found in 120(88.9%) cases and in 38(28.1%) controls with odd ratio 20.4211 at 95 %CI and p value <0.001.Hypercholesterolemiawas seen in 49(36.3%) of the cases while in 21(15.6%) of control group (without ACS) with odd ratio of 3.3 and p-value <0.001. Odds ratio was maximum for Non HDL cholesterol, followed by LDL cholesterol, HDL cholesterol and Total cholesterol. Conclusion: Non-HDL cholesterol showed a good association in patients with ACS than with primary target LDL-C or total cholesterol.