Objective: To explore the detection value of apolipoprotein A1/apolipoprotein B (ApoA1/B), albumin-to-globulin ratio (A/G) combined with D-dimer (D-D) on patients with coronary atherosclerotic heart disease (CHD). Methods: 68 patients with CHD who were treated in the hospital from January 2024 to March 2025 were collected as case group, and 68 non-CHD patients who received related examinations for other reasons were selected as control group. The levels of ApoA1/B, A/G and D-D were compared between the two groups. Pearson correlation analysis was used to analyze the correlation between ApoA1/B, A/G and D-D levels and CHD-related indicators. The diagnostic efficiency of ApoA1/B, A/G, D-D and combined detection on CHD was analyzed by receiver operating characteristics curve. Results: The C-reactive protein (CRP) and low-density lipoprotein cholesterol (LDL-C) in case group were higher while the high-density lipoprotein cholesterol was lower (P<0.05). The ApoA1/B and A/G were lower while the level of CK-MB was higher in case group (P<0.05). In case group, LDL-C was negatively correlated with ApoA1/B, and HDL-C was positively correlated with A/G, and CRP was negatively correlated with A/G, and CRP was positively correlated with D-D (P<0.05). The combination of ApoA1/B, A/G and D-D had the highest diagnostic efficiency on CHD, with Youden index of 0.706, area under the curve of 0.944, sensitivity of 92.65% and specificity of 77.94% respectively. Conclusion: ApoA1/B, A/G combined with D-D detection has high diagnostic value on CHD.