Objective: To investigate the effects of rosuvastatin combined with metoprolol on left ventricular function, serum N-terminal pro-brain natriuretic peptide (NT-proBNP), and apolipoprotein A-1 (apoA-1) in patients with coronary heart disease (CHD) and chronic heart failure (CHF). Methods: Totally 80 patients with CHD and CHF who were admitted to the Department of Cardiology, the First Affiliated Hospital of Henan University from June 2023 to October 2024 were enrolled in this study. Using a table of random numbers, they were divided into the combination group (n=40) and the metoprolol group (n=40). The metoprolol group received conventional anti-heart failure treatment and treatment with metoprolol, while the combination group was additionally treated with rosuvastatin based on the treatment of the metoprolol group. Both groups were given 6 months of continuous treatment. Clinical efficacy, cardiac function, NT-proBNP, and apoA-1 levels were compared between the two groups, and the incidence of adverse reactions was recorded. Results: After treatment, the total effective rate in the combination group (95.00%) was higher than that in the metoprolol group (77.50%) (P<0.05). The combination group showed higher left ventricle ejection fraction (LVEF), smaller left ventricular end-diastolic diameter (LVEDd), and lower heart rate in resting state compared with the metoprolol group (P<0.05). The combination group exhibited lower NT-proBNP levels and higher apoA-1 levels than the metoprolol group (P<0.05). The incidence of adverse reactions was comparable between the two groups (P>0.05). Conclusion: Rosuvastatin combined with metoprolol is effective in treating CHD complicated with CHF. It can improve left ventricular function, reduce NT-proBNP level, and increase apoA-1 level, with favorable safety.