Background and study aim: Non-alcoholic fatty liver disease (NAFLD) has an increasing prevalence worldwide. It has also been closely associated with obesity and metabolic syndrome - two conditions known to be associated with ischemic heart disease (IHD). The aim of this study was to assess the association between NAFLD and ischemic heart disease. Subjects and Methods: 140 patients with NAFLD and 70 non-NAFLD subjects were selected. Full history taking, clinical examination and laboratory tests including blood sugar, lipid profile and liver profile were done. Ultrasonography was performed to prove NAFLD while ECG and echo-cardiography were used for detection of myocardial ischemia. Results: Of the NAFLD group, the frequency of mild, moderate and severe NAFLD was 42.9%, 30% and 27.1% respectively. Subjects with NAFLD had a significantly higher BMI, waist circumference and weight compared to those of non NAFLD group (p=0.014, 0.0218 and <0.001 respectively). Independent risk factors for NAFLD were obesity, DM, high LDL, low HDL, waist circumference,   glycated hemoglobin and IHD with odds ratios  1.09, 2.12, 1.01, 1.15, 1.13, 1.37 and 1.17 respectively. While independent risk factors for IHD included obesity, DM, high LDL, total cholesterol, triglycerides  and the presence of NAFLD with odds ratios 1.31, 1.23, 1.19, 1.132, 1.68 respectively. Conclusion: NAFLD was independently associated with increased risk of myocardial ischemia.