Objective To analyze the effects of serum uric acid and lipid levels on intestinal microflora environment in elderly patients with coronary heart disease (CHD) combined with type 2 diabetes mellitus (T2DM), and to provide reference for the treatment of elderly patients with CHD combined with T2DM. Methods In the experimental group, 160 elderly patients with CHD complicated with T2DM who were treated in our hospital from January 2020 to January 2021 were selected, all of whom were over 60 years old. According to the level of uric acid (UA), they were divided into high uric acid group (n=62) and normal uric acid group (n=98). According to the total cholesterol (TC) level, the patients were divided into high cholesterol group (n=74) and normal blood lipid group (n=86). Sixty elderly normal patients treated at the same time were selected as the control group. The levels of uric acid, low density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) were determined and analyzed by biochemical analyzer. The distribution of intestinal flora (bifidobacteria, Lactobacillus, Escherichia coli, Helicobacter pylori, streptococcus) in stool samples of all patients was determined. Spearman linear correlation analysis was used to analyze the correlation between serum uric acid, lipid levels and intestinal microflora distribution in elderly patients with coronary heart disease. Results The serum LEVELS of UA, LDL-C and TC in experimental group were significantly higher than those in control group (P<0.05). Lactobacillus and bifidobacterium in high cholesterol group were significantly lower than those in normal blood lipid group, escherichia coli in high cholesterol group was significantly higher than that in normal blood lipid group (P<0.05), and there was no statistical significance in helicobacter pylori and Streptococcus between the two groups (P>0.05). Bifidobacteria and lactobacillus in high uric acid group were significantly lower than those in normal uric acid group (P<0.05), escherichia coli, Helicobacter pylori and Streptococcus in high uric acid group were significantly higher than those in normal uric acid group (P<0.05). Spearman correlation analysis showed that UA was negatively correlated with bifidobacteria and lactobacillus, and the correlation coefficient was (r₁=-0.512 , r₂=-0.439 , P<0.05). UA was positively correlated with Escherichia coli, Helicobacter pylori and Streptococcus, with correlation coefficients (r₁=0.491,r₂=0.396, r₃=0.218,P<0.05). Spearman correlation analysis showed that TC was negatively correlated with bifidobacteria and lactobacillus, and the correlation coefficient was (r₁=-0.492,r₂=-0.427, P<0.05). TC was positively correlated with EScherichia coli (r=0.417, P<0.05). Ldl-c was negatively correlated with bifidobacterium and lactobacillus, and the correlation coefficient was (r₁=-0.457,r₂=-0.404, P<0.05). Ldl-c was positively correlated with EScherichia coli(r=0.404, P<0.05). Conclusions: Elderly CHD patients with T2DM had abnormal intestinal flora distribution, and the abundance of intestinal flora was correlated with blood lipid and uric acid levels in CHD patients with T2DM.