Coronary artery disease (CAD) is the global leading cause of death for both men and women. Risk factors for CAD have been studied extensively and subsequently preventive and treatment measures have been prioritized globally. Nevertheless, the prevalence and mortality rate of CAD remains high. We attempted to identify the most common of the well-known risk factors for developing CAD in a rural population in Malaysia using a retrospective cross-sectional, hospital-based study from January, 2010 to June, 2011. Smoking was the most important independent risk factor for the entire male population (non-female smokers in population). In the population studied, smoking remains the most important health factor in development of CAD.