Objective To investigate the effects of atorvastatin combined with trimetazidine on cardiac function and inflammatory factors in elderly patients with coronary heart disease (CHD). Methods This study included 120 elderly patients with coronary heart disease who visited the cardiovasology department of the Second Affiliated Hospitao of Xi’an Jiaotong University from January 2022 to December 2023. The patients were evenly divided into an observation group and a control group using a random number table method, with 60 cases in each group. The control group received atorvastatin calcium tablets at a dose of 20 mg once daily, while the observation group received trimetazidine hydrochloride tablets at a dose of 20 mg three times daily in addition to the atorvastatin. Both groups were treated for 12 weeks. Clinical efficacy, cardiac function indicators (LVESD, LVEDD, LVEF), and levels of inflammatory factors (IL-6, TNF-α, IL-10) were compared between the two groups. Results The overall effective rate in the observation group (96.67%) was significantly higher than that in the control group (80.00%) (P ＜ 0.05). After treatment, the improvement in LVESD, LVEDD, and LVEF in the observation group was significantly better than in the control group (P ＜ 0.001). The levels of IL-6 and TNF-α were significantly reduced, and IL-10 levels were significantly increased in the observation group compared to the control group (P ＜ 0.001). There was no significant difference in the incidence of adverse reactions between the two groups (P ＞ 0.05). Conclusions The combination of atorvastatin and trimetazidine for the treatment of elderly patients with coronary heart disease can significantly improve patients’ cardiac function, regulate inflammatory factor levels, and demonstrates good safety, making it worthy of clinical promotion and application.