OBJECTIVE: This study aimed to explore the importance of the triglyceride-glucose (TyG) index and triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) ratio in predicting the risk of coronary heart disease (CHD) in elderly postmenopausal women. METHODS: This was a retrospective cohort study conducted from March 2018 to February 2019. A total of 749 natural menopausal elderly women aged ≥60 years who were hospitalized in the Department of Cardiology, First Affiliated Hospital of the University of Science and Technology of China and underwent coronary angiography for the first time were divided into CHD group (527 patients) and non-CHD group (222 patients). The clinical data parameters used in this analysis were chosen based on literature support and clinical findings related to CHD in elderly postmenopausal women. The clinical data of the two groups were compared, and the predictive value of the TyG index and TG/HDL-C was analyzed by m ultivariable logistic regression analysis and the receiver operating characteristic (ROC) curves. RESULTS: Multivariable logistic regression analysis showed that hemoglobin (Hb), high-sensitivity C-reactive protein (hs-CRP), TyG index, TG/HDL-C, daily sleep duration and glycosylated hemoglobin (HbA1c) were independent influencing factors of CHD in elderly postmenopausal women (P < 0.05). The results of Spearman correlation analysis showed that the TyG index and TG/HDL-C ratio positively correlated with the Gensini score (r = 0. 322 and r = 0.342, respectively; P < 0.01). The ROC curve analysis showed that the area under the ROC curve of TyG index and TG/HDL-C for predicting the risk of CHD was 0.740 (95% CI [0.703-0.777]; P < 0.01) and 0.771 (95% CI [0.737-0.805]; P < 0.01), respectively. CONCLUSION: This study demonstrates that the TyG index and TG/HDL-C ratio are significantly associated with CHD risk in elderly postmenopausal women, as evidenced by their acceptable predictive performance (AUC: 0.740-0.771) and independent statistical significance (P < 0.05). While the observed correlations with coronary artery stenosis (Gensini score: r = 0.322-0.342) were statistically significant but numerically weak, these markers remain clinically useful screening tools. Further validation studies are warranted to confirm their role in risk stratification.