Background: Coronary heart disease (CHD) remains the major cause of mortality and morbidity in the entire world population despite therapeutic advances that control many risk factors. Lipid profile is regarded as an important factor in the development of coronary heart disease. There have been numerous studies showing the association of hyperlipidemias with coronary heart disease in most of the Western as well as Asian countries of the world. But we have very little data on the relation between CHD and lipid profile in this part of the globe. Objective: To evaluate the association between lipid profile and acute coronary syndrome (ACS). Methods: This cross-sectional study was done in the Department of Biochemistry in collaboration with the Department of Cardiology, Regional Institute of Medical Sciences, Imphal on diagnosed cases of acute coronary syndrome in between January 2021 to October 2022. Estimation of lipid profile was done by Randox Imola autoanalyzer. Data collected were entered in SPSS version 21.0 and analysed using descriptive measures, and statistical significances were set at p<0.05. Results: A total of 67 patients of acute coronary syndrome and 67 without acute coronary syndrome (total 134) were recruited in the study. It is seen that the mean±SD of age in cases was 63.69±12.11 years and in the controls, it was 45.47±11.75 years, and the difference observed was found to be statistically significant p<0.05. The majority of the cases were males comprising of 49 (73.3%) and females constitute only 18 (26.7%). 42 (62.2%) of the cases had history of HTN while 25 (37.8%) had no h/o HTN. In cases the mean±SD of SBP (112.67±17.35 mmHg) and DBP (73.38±11.63 mmHg) were found to be significantly lower than the controls. As regards the lipid profile, in the cases the mean±SD of total cholesterol was 208.75±31.25 mg/dl and in controls 144.02±19.57 mg/dl, triglycerides in cases was 162.51±39.81 mg/dl and 98.42±16.96 mg/dl in controls and LDL was 142.22±31.31 mg/dl in the cases and 71.40±21.24 mg/dl in controls showing that the values were higher in the cases as compared to the control group and the difference was found to be statistically significant with p<0.05. However, the mean±SD of HDL in the cases (34.78±6.44 mg/dl) was lower as compared to the controls (49.56±5.72 mg/dl) and the difference was statistically significant with p<0.05. Conclusion: In this study, it was found that the total cholesterol, triglycerides, and LDL cholesterol concentrations were significantly higher and HDL concentration was lower in acute coronary syndrome (ACSD) patients. The imbalance between TC and HDL levels plays a more important role in the pathophysiology of atherogenesis leading to ACS.