To investigate the diagnostic value of diagonal earlobe crease (DELC) combined with lipoprotein(a) [Lp(a)] for coronary heart disease (CHD). A total of 862 chest paint patients suspected of CHD were admitted to Chengde Central Hospital between September 2021 and December 2023. According to CAG results, patients were categorized into the experimental group and the control group. Multifactorial logistic analysis was used to analyze association between DELC and Lp(a) levels with the risk of developing CHD. The diagnostic efficacy of DELC, Lp(a) for CHD was evaluated by receiver operating characteristic (ROC) and area under the curve (AUC). The results showed that DELC and Lp(a) were positively correlated with CHD. Age, sex, hypertension, diabetes mellitus, alopecia, DELC, TG and Lp(a) were independent risk factors for CHD. The CHD diagnostic model was constructed based on these risk factors, with the Hosmer-Lemeshow test (P = 0.683) confirming a good fit. The subjects were categorized into group A, B, C, and D, taking group A as the reference group, and the OR values of groups C and D were significantly increased after multi-factor correction. The area under the DELC and Lp(a) curves calculated by ROC curve was 0.729, indicating a strong diagnostic value for CHD. DELC and Lp(a) were independent risk factors for CHD. The combination of DELC and Lp(a) had good application value in the diagnosis of CHD.