Coronary heart disease (CHD) affects millions of individuals worldwide and remains a leading cause of morbidity and mortality. It compromises quality of life primarily through myocardial ischemia resulting from progressive coronary arterial narrowing and contributes to a wide range of adverse clinical outcomes. Although current therapeutic strategies, including coronary revascularization, lipid-lowering therapy, and plaque stabilization, have substantially improved patient prognosis, they do not fully address the underlying immunopathological mechanisms driving disease progression. Increasing evidence suggests that immune-mediated inflammation and vascular injury play critical roles in the initiation, progression, and destabilization of atherosclerotic plaques, highlighting the immune system as a potential therapeutic target in CHD management. In this review, we summarize recent advances in our understanding of the contributions of innate and adaptive immune responses to CHD pathogenesis. Collectively, current evidence indicates that immune dysregulation is a central driver of atherogenesis and its clinical manifestations, supporting the development of targeted immunomodulatory strategies as promising approaches for the prevention and treatment of CHD.