Objective Early identification of coronary artery disease (CAD) is crucial for improving prognosis. This study investigated the relationship between an oxidative stress-lipid metabolism composite biomarker (Hpx·apoB) and CAD, and evaluated its value for clinical risk stratification. Methods The study utilized liquid chromatography-tandem mass spectrometry (LC-MS/MS) to quantify plasma Hpx levels in 107 CAHD patients and 33 controls without CAHD, while also gathering relevant clinical data. We analyzed the correlation between Hpx·apoB and CHD and developed a clinical predictive model. Predictive performance was assessed using receiver operating characteristic (ROC) curve analysis and net reclassification improvement (NRI). Results The HPX·apoB levels were markedly higher in the CAHD group compared to the control group (P<0.01). Significant increases in Hpx·apoB were observed in patients with acute myocardial infarction, acute coronary syndrome, and multivessel diseased group (all P<0.01). Multivariate analysis identified Hpx·apoB as an independent risk factor for CAHD (OR=2.554, 95% CI: 1.336-4.881, P<0.01). ROC analysis demonstrated: Standalone predictive AUC=0.667;Combined with CRP+LDL-C: ΔAUC=+0.106 (P<0.05), NRI=15.6% (P<0.05);Integrated with Framingham score: ΔAUC=+0.076 (P=0.139), NRI=27.0% (P<0.01);Integrated with SCORE model: ΔAUC=+0.142 (P=0.093), NRI=37.6% (P<0.001). Further subgroup analysis revealed that the predictive strength of HPX·apoB for CAHD was particularly pronounced in males, smokers, and individuals with renal impairment(P<0.05). Conclusion Hpx·apoB, as a composite biomarker reflecting oxidative stress and lipid metabolism, independently predicts CAD risk. Its combination with clinical risk scores significantly improves risk prediction performance.