Aim To investigate the effects of Musk Baoxin pill combined with rosuvastatin on blood lipid, vascular endothelial function and expression of microRNA-126 and microRNA-137 in peripheral blood of elderly patients with coronary heart disease. Methods The 94 elderly patients with coronary heart disease were divided into control group (47 cases) and observation group (47 cases) by random number table method. The patients in control group were treated with rosuvastatin, while the patients in observation group were treated with Musk Baoxin pill on the basis of control group.Both groups were treated for 12 weeks. The therapeutic effect, blood lipid, vascular endothelial function and expression of microRNA-126 and microRNA-137 in peripheral blood were compared between two groups before and after treatment. Results The total effective rate of observation group (93.62%) was higher than that of control group (70.21%, P<0.05). After treatment, total cholesterol (TC), low-density lipoprotein cholesterol (LDLC) and triglyceride (TG) levels were lower in two groups than those before treatment, while high-density lipoprotein cholesterol (HDLC) levels were higher than those before treatment (P<0.05); after treatment, TC, LDLC and TG levels in observation group were lower than those in control group, while HDLC levels were higher than those in control group (P<0.05). After treatment, endothelin-1 (ET-1) level in two groups was lower than that before treatment, while nitric oxide (NO) level was higher than that before treatment (P<0.05); after treatment, ET-1 level in observation group was lower than that in control group, while NO level was higher than that in control group (P<0.05). After treatment, the expression of microRNA-126 increased and microRNA-137 decreased in both groups (P<0.05); after treatment, the expression of microRNA-126 in observation group was higher than that in control group, while the expression of microRNA-137 was lower than that in control group (P<0.05). Conclusions Musk Baoxin pill combined with rosuvastatin has a good effect on elderly patients with coronary heart disease. It can improve blood lipid metabolism disorder and vascular endothelial dysfunction, and up-regulate microRNA-126 expression in peripheral blood and down-regulate microRNA-137 expression, which is worthy of clinical reference.