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ObjectiveCoronary heart disease (CHD) constitutes a primary cause of morbidity and mortality worldwide. The estimated glucose disposal rate (eGDR) serves as a surrogate marker of insulin resistance, whereas the albumin-bilirubin (ALBI) score reflects liver-related systemic status. However, their joint associations with CHD have not been well characterized.MethodsWe conducted a cross-sectional analysis of participants from the National Health and Nutrition Examination Survey (NHANES) from 1999 to March 2020. Survey-weighted logistic regression models were used to evaluate the individual and joint associations of eGDR and ALBI with CHD prevalence. Restricted cubic spline (RCS) models were applied to assess nonlinear associations. Subgroup, complete-case, covariate-exclusion, and age-stratified sensitivity analyses were performed to evaluate robustness of the findings.ResultsA total of 18,712 participants, involving 725 with CHD, were included. In the fully adjusted model, higher eGDR was associated with lower odds of CHD (odds ratio [OR] 0.740, 95% confidence interval [CI] 0.687-0.797; P < 0.001), whereas higher ALBI was associated with greater odds of CHD (OR 1.779, 95% CI 1.231-2.570; P = 0.002). RCS analysis showed a nonlinear inverse association for eGDR and an approximately linear positive association for ALBI. The high-ALBI/low-eGDR group had the highest odds of CHD compared with the low-ALBI/high-eGDR group (OR 4.307, 95% CI 2.530-7.332; P < 0.001). The principal findings remained consistent across all sensitivity analyses.ConclusionLower eGDR and higher ALBI were each associated with higher CHD prevalence. Their joint assessment may provide complementary information for population-level cardiometabolic risk evaluation, although longitudinal validation is required.