Objective To determine the effect of simdestatin on the blood lipid level, liver damage and clinical prognosis of elderly patients with coronary heart disease carrying hepatitis B virus (HBV). Methods A total of 110 elderly HBV carriers with coronary heart disease admitted in our hospital from December 2018 to December 2019 were recruited in this study. They were randomly divided into control group (comprehensive treatment of Western medicine) and treatment group (added with simvastatin treatment). After 6 consecutive months′ treatment, the blood lipid levels, liver damage, HBV DNA load and reactivation were compared between the 2 groups, and the impact on the prognosis was further analyzed. SPSS statistics 23.0 was used for data analysis, and one-way analysis of variance, student′s t test or Chi-square test was performed for comparison between groups depending on different data types. Results The levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) were decreased and that of high-density lipoprotein cholesterol (HDL-C) was increased in the 2 groups after treatment and during follow-up. The levels of TC and LDL-C were significantly lower and the HDL-C level was significantly higher in the treatment group than the control group during follow-up (P<0.05). After 3 and 6 months of treatment and during follow-up, the treatment group obtained obviously lower HBV DNA load than the control group [(2.82±0.46)×10⁶ vs (6.63±1.58)×10⁶copies/ml, (2.52±0.38)×10⁶vs (6.54±1.55)×10⁶copies/ml, (2.11±0.20)×10⁶vs (6.88±1.78)×10⁶copies/ml, P＜0.05]. The HBV DNA reactivation rate were significantly lower (7.27% vs 45.45%, P<0.05) and prognosis results were better in the treatment group than the control group in follow-up period. But there was changes in treatment regimens (P<0.05), but no significant difference in liver and kidney damage between the 2 groups (P>0.05). Conclusion Simvastatin not only exerts good effectiveness in regulating lipids, but also inhibits the replication and reduces the reactivation rate of HBV DNA in the treatment of elderly HBV-carrying patients with coronary heart disease. It has no effect on aggravating liver damage, and shows good safety.