Objective: To study the influence of coenzyme Q10 (CoQ10) combined with clopidogrel on angina pectoris attack, myocardial enzymes and inflammatory factors in elderly patients with coronary heart disease (CHD). Methods: Eighty-six elderly patients with CHD admitted to the hospital from April 2022 to April 2024 were included and randomly divided into combined group (n=43) and control group (n=43) by lottery method. The control group was treated with clopidogrel hydrogen sulfate tablets, while the combined group was given CoQ10 capsules combined with clopidogrel hydrogen sulfate tablets. The weekly attack frequency and duration of angina pectoris, myocardial enzymes indexes [creatine kinase myocardial band (CK-MB), lactate dehydrogenase (LDH), creatine kinase (CK)] and inflammatory factors [high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)] before and after treatment and occurrence of adverse reactions during medication were compared between the two groups of patients. Results: After treatment, the weekly attack frequency of angina pectoris and the longest duration of single attack, and levels of CK-MB, LDH, CK, hs-CRP, IL-6 and TNF-α in the two groups were significantly reduced compared with those before treatment, and the above indexes in combined group were significantly lower than those in control group (P<0.05). There were no significant differences in the adverse reactions between the two groups during treatment (P>0.05). Conclusion: CoQ10 combined with clopidogrel can significantly reduce the attack frequency of angina pectoris and shorten the longest duration of single attack in elderly patients with CHD, relieve the myocardial injury and control the inflammatory response, and it is worthy of clinical promotion and application.