Background: While the connection between environmental lead exposure and cardiovascular disease (CVD) is well-known, the association with silent myocardial infarction (SMI) remains unexplored. Aims: Our objective was to examine if there is a connection between higher blood lead levels (BLL) and increased prevalence of SMI in the general population. Methods: This analysis included 7,283 (mean age 56.1±2.52 years, 52.5% women, 49.8% Whites) participants from the Third National Health and Nutrition Examination Survey who were free of CVD. Graphite furnace atomic absorption spectrophotometry was used to measure blood lead levels (BLL). SMI was defined as the presence of electrocardiographic evidence of myocardial infarction (MI) without a prior history of MI. Multivariable logistic regression analysis was used to examine the cross-sectional association between baseline BLL and SMI. Results: Participants with higher levels of BLL had a higher prevalence of SMI (SMI prevalence 0.4%, 0.9% and 2.4% across BLL tertiles). In a multivariable-adjusted model, the highest BLL tertile was associated with over three times the odds of SMI compared to the first tertile, with an odds ratio of 3.42 (95% CI: 1.76-6.63). There was a 9% increase in the odds of SMI for every 1 μg/dL increase in BLL (Table). This association was consistent across subgroups stratified by median age, sex, and race. Conclusion: Higher BLL levels are associated with a higher likelihood of SMI in the general US population. These results underscore the ongoing need for efforts to minimize lead exposure among the general public.