INTRODUCTION: Dyslipidemia remains a significant risk factor for atherosclerosis and the development of acute coronary syndrome (ACS). Consistent data have demonstrated challenging lipid control according to the European Society of Cardiology (ESC) guideline-directed target low-density lipoprotein cholesterol (LDL-C) level. The exact prevalence of dyslipidemia in Tanzania remains unclear, although it is known to be quite high, and higher in urban than in rural areas. This study aimed to evaluate the current practice of lipid assessment in patients admitted with ACS and compliance with national and international guidelines. METHODOLOGY: This retrospective hospital-based cohort study aimed to determine the current practice of dyslipidemia screening in patients with ACS admitted to the Jakaya Kikwete Cardiac Institute (JKCI) and evaluate their adherence to national and international recommended guidelines, such as ESC and American Heart Association guidelines. All patients admitted to the JKCI from June 2023 to June 2024, aged 18 years or older, and presenting with ACS, were included in this study. Data were collected using a prestructured tool created with Google Forms (Google, Mountain View, CA). Data extraction was performed in MS Excel (Microsoft Corporation, Redmond, WA) and then transferred to R software (R Foundation for Statistical Computing, Vienna, Austria) for analysis. This information is summarized in tables, graphs, and frequencies. RESULTS: This study included 124 patients diagnosed with ACS admitted to the JKCI center. Of this cohort, 58 (47%) patients had their LDL-C levels checked within 48 hours of presentation. The follow-up of lipids after admission was documented in 10% of the patients. Only 9.5% achieved the guideline-recommended LDL-C goal. Most patients were initiated on and maintained on a high-intensity statin, with no data on the use of nonstatin therapy. CONCLUSION: The findings of this study have mirrored many irregularities in the current practice of dyslipidemia screening among patients with ACS admitted to JKCI. This study also highlighted the local nonadherence to national and international recommended guidelines, which, in turn, undermines secondary prevention of cardiovascular events. Further larger multicentered studies are recommended to assess the scope of the problem to reduce the burden and risk of future events.