There is growing evidence that environmental noise exposure could increase the risk of atherothrombotic events, including acute myocardial infarction (MI). We analysed the burden of environmental noise on atherothrombotic risk in MI patients. From the RICO survey, 879 consecutive MI patients included from 2004 to 2008 and living in an urban unit of > 237,000 inhabitants were analysed. Atherothrombotic risk was calculated using the TRS-2P score. TRS-2P categories were split into low (TRS-2P = 0/1) (40.8%), medium–low (TRS-2P = 2) (25.7%), medium–high (TRS-2P = 3) (21.8%) and high risk (TRS-2P ≥ 4) (11.6%). Noise exposure was associated with atherothrombotic risk, with the LAeq,24 h (OR (95% CI): 1.165 (1.026–1.324)) and Lnight (OR (95CI): 1.157 (1.031–1.298)), for each 10 dB(A) increase. After adjustment, noise exposure remained a predictor of atherothrombotic risk, with LAeq,24 h (OR (95% CI): 1.162 (1.011–1.337)) and with Lnight (OR (95% CI): 1.159 (1.019–1.317)). The relationship with transportation Lnight was significant for men (OR (95% CI): 1.260 (1.078–1.472)) but not for women (OR (95% CI): 0.959 (0.763–1.205)). We found a significant association between residential traffic noise exposure and atherothrombotic risk in men but not in women. These results could have major consequences for secondary prevention.