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Adopting sustainable dietary patterns is essential for planetary and human health. As data to address this issue are lacking in Latino populations, this study examined the association between diet-attributable greenhouse gas emissions (GHGEs) and myocardial infarction (MI) in a Costa Rica Heart Study. This analysis included 1817 cases of a first non-fatal acute MI during hospitalization and their matched population-based controls, by age, sex, and area of residence. A validated food frequency questionnaire was used to quantify habitual dietary intake and diet-attributable GHGEs (kg CO₂ equivalent (eq.)/year). Due to the matching design, conditional logistic regression was used. Red meat consumption contributed approximately 50% to the total diet-attributable GHGEs among both cases and controls. Higher diet-attributable GHGEs were associated with increased odds of acute MI. The odds of MI were 63% higher (OR = 1.63; 95% CI 1.20–2.21) among participants in the highest quintile (median diet-attributable GHGEs = 6247 kg CO₂ eq./year) compared to the lowest quintile (median diet-attributable GHGEs = 2065 kg CO₂ eq./year). An increasing linear trend in the odds of acute MI and diet-attributable GHGEs was detected (<i>p</i>-trend 0.0012). These findings highlight the importance of reducing red meat consumption to sustainably mitigate the incidence of MI and improve planetary health.