The study was conducted over a 5-year period and included all patients hospitalized in KB Dubrava under the diagnosis of acute coronary syndrome. The gravitational area of KB Dubrava, in addition to part of the city of Zagreb and Zagreb County, also includes Međimurje, Varaždin and Koprivnica-Križevci counties. These localities and counties are considered areas of high density of Roma population. Patients were divided into two groups, Roma (95 respondents) and non-Roma (372), which were adjusted and controlled according to age and gender, based on ethnicity, which was assessed by specific phenotype and further confirmed orally. Ischemic heart disease of the Roma group was studied in the context of acute coronary syndrome with weight determination by coronary artery angiography and well-validated coronary angiographic scoring systems, Syntax and Gensini score. The prevalence of selected cardiovascular risk factors was determined and the possible specificity of coronary heart disease of the Roma group in correlation with selected demographic-educational and cardiovascular risk factors was investigated. Higher extension and complexity of coronary heart disease in the Roma group were shown, with significant differences in smoking, higher levels of glycated hemoglobin and serum triglycerides and educational status. There were no significant differences in the representation of other, traditional risk factors among the examined groups. The proven “severe” coronary heart disease of the Roma group cannot probably be explained only by the greater severity of certain traditional risk factors. Additional factors of socio-economic status, psychosocial factors and a sense of coherence should be considered and expressed in more detail when considering possible interaction. Additional genetic research of a specific genotype for “more severe” forms and outcomes of coronary heart disease could provide additional explanations. Inadequate access to health services, specific culture and customs, language barriers and discrimination are some of the components that could also play a role and should not be neglected. The results of this research should supplement the scarce data on ischemic heart disease of Roma in the northwestern part of Croatia and be a stimulus for new research on this historically most intriguing ethnic minority in order to improve Roma health taking into account all cultural specifics.