Myocardial Infarction is the number one cause of death in Malaysia. Among all individuals who have Myocardial Infarction, lower income households are the most affected group by this disease. Smoking will increase the risk of having Myocardial Infarction. Smokers are usually found in the lower income group. Lower income households who suffer Myocardial Infarction will face economic burden since the cost of Myocardial Infarction treatment is high. Due to financial constraints, many lower income individuals are not able to participate in insurance or takaful product. Moreover, smoking will increase the rate of premium for insurance and takaful hence increase the difficulty for the individuals to join the insurance or takaful scheme. The objective of this study is to investigate the association of smoking with Myocardial Infarction in Malaysia. This study used a narrative literature review to review paper related to smoking and Myocardial Infarction. From this study, we found that there are many controllable risk factors of Myocardial Infarction. Smoking status is the most significant risk factor of Myocardial Infarction. Smoking will increase the risk of an individual to have Myocardial Infarction. Other than that, most of the smokers were lower income group. B40 income group in Malaysia use 2.3% of their income for alcoholic beverage and tobacco. This is high compared to the M40 and T20 income group. Smoking not only triggered the risk of having Myocardial Infarction but also bring other dangerous effects such as respiratory disease and cancer. A further study on modelling the risk of myocardial infarction related to smoking and myocardial infarction is needed to understand the real association of smoking with Myocardial Infarction especially among lower income individuals in Malaysia.