This study investigated the association between APOE gene polymorphisms and coronary heart disease (CHD) risk in 60 Libyan patients. The researchers found that 75% of patients carried ε4-containing genotypes, with E2/4 being the most common (45%)—a frequency substantially higher than reported in European and Asian populations. A significant gene-environment interaction was observed between smoking and APOE genotype among male patients (p = 0.001). This represents the first genetic data on APOE polymorphisms in the Libyan population, highlighting the potential role of APOE ε4 alleles in CHD susceptibility in North African populations.