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Cardiovascular diseases (CVDs) are major contributors to morbidity and mortality in lower-middle-income countries (LMICs). Features of the natural environment, such as greenness, are a potential, modifiable determinant of CVD, yet there is a lack of evidence, particularly in LMICs. Our study investigated associations between residential greenness, measured using the Normalized Difference Vegetation Index (NDVI), and self-reported heart disease in 5268 Sri Lankan men aged 34 to 55 years. Multivariable logistic regression models were fitted to examine associations between mean NDVI within 100 m, 400 m, 800 m, 1600 m, and 2000 m of the residential address, adjusting for age, marital status, income, education, alcohol consumption, smoking and road length. Fully adjusted models showed that a 0.1 increase in mean NDVI was associated with lower odds of heart disease when using the 400 m (OR: 0.80; 95% CI: 0.64, 1.00), 800 m (OR: 0.85; 95% CI: 0.63, 1.14), and 2000 m (OR: 0.74; 95% CI: 0.48, 1.13) buffers. Further research in different contexts, and with improved outcome measures, is needed to confirm relationships between residential greenness and heart disease in rural areas and in LMICs.