Background: Cardiovascular diseases (CVDs) remain a leading cause of morbidity and mortality worldwide; with ischaemic heart disease (IHD) being one of the most prevalent conditions affecting millions of individuals annually.This study aims to evaluate the impact of dyslipidaemia on echocardiographic markers of myocardial contractility in smokers with ischaemic heart disease (IHD). The study investigates the relationship between lipid abnormalities and myocardial dysfunction in this high-risk population. Material and Methods: A total of 100 patients diagnosed with IHD, all of whom were smokers with a history of smoking for at least five years, were included in this study. Baseline demographic data, including age, sex, body mass index (BMI), duration of smoking, and blood pressure, were recorded. Laboratory investigations included fasting lipid profile assessments of total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides. Echocardiographic evaluations were performed to assess left ventricular ejection fraction (LVEF), fractional shortening (FS), and regional wall motion abnormalities (RWMA), as well as myocardial velocities using tissue Doppler imaging (TDI). Statistical analysis was conducted using SPSS, with a p-value of <0.05 considered statistically significant. Results: The mean age of the participants was 56.4 ± 10.2 years, with 85% being male. The mean BMI was 27.6 ± 3.4 kg/m², and the mean duration of smoking was 18.3 ± 7.5 years. The lipid profile analysis revealed dyslipidaemia, with elevated total cholesterol (210.5 ± 35.2 mg/dL), LDL-C (135.7 ± 28.4 mg/dL), and triglycerides (185.6 ± 45.3 mg/dL), while HDL-C was reduced (38.5 ± 6.2 mg/dL). Echocardiographic findings showed left ventricular dysfunction, with a mean LVEF of 48.3 ± 8.7% and evidence of diastolic dysfunction in 45% of patients. RWMA was present in 65% of patients, indicating a high prevalence of ischemia-induced myocardial dysfunction. A significant association was observed between lipid abnormalities and impaired myocardial contractility, with higher LDL-C and triglyceride levels in patients with reduced LVEF. Conclusion: The study highlights the adverse effects of smoking-induced dyslipidaemia on myocardial contractility in patients with IHD. The findings underscore the strong correlation between abnormal lipid profiles and left ventricular dysfunction, emphasizing the need for targeted interventions, including smoking cessation and lipid-lowering therapies, to mitigate cardiovascular risks.