Objective: To investigate changes in low-density lipoprotein cholesterol (LDL-c), homocysteine (Hcy), and high-sensitivity troponin I (hs-cTnI) levels and their clinical significance in elderly hypertensive patients. Methods: A total of 84 elderly patients with hypertension who were treated in our hospital from January 2024 to December 2025 were enrolled as the study group, and 84 elderly healthy subjects who underwent physical examination during the same period were selected as the control group. Levels of low-density lipoprotein cholesterol (LDL-c), homocysteine (Hcy), high-sensitivity troponin I (hs-cTnI), triglycerides (TG), total cholesterol (TC), and high-density lipoprotein cholesterol (HDL-c) were detected in both groups. Differences in each index between the two groups were compared. Univariate analysis was used to screen for factors related to cardiovascular risk in elderly hypertensive patients, and Logistic regression analysis was performed to identify independent risk factors for cardiovascular events in elderly hypertensive patients. Results:The levels of TC, Hcy, hs-cTnI, LDL-c, and TG in the study group were significantly higher than those in the control group, while the HDL-c level was lower than that in the control group (P < 0.05). Univariate analysis showed that age ≥ 70 years, hypertension duration ≥ 10 years, combined diabetes mellitus, combined hyperlipidemia, elevated LDL-c, elevated Hcy, and elevated hs-cTnI were associated with cardiovascular risk in elderly hypertensive patients (P < 0.05). Logistic regression analysis revealed that elevated LDL-c (OR=3.892, 95%CI: 1.653~9.178), elevated Hcy (OR=4.215, 95%CI: 1.876~9.453), elevated hs-cTnI (OR=5.126, 95%CI: 2.135~12.317), and hypertension duration ≥ 10 years (OR=2.987, 95%CI: 1.234~7.215) were independent risk factors for cardiovascular risk in elderly hypertensive patients (P < 0.05). Conclusion: Elderly hypertensive patients exhibit abnormally elevated levels of LDL-c, Hcy, and hs-cTnI. These three indicators are independent risk factors for cardiovascular risk, and clinical monitoring of these levels, combined with patient disease duration, can provide reference for cardiovascular risk assessment and intervention in elderly hypertensive patients, thereby improving patient prognosis.