Background: Risk assessment tools play a pivotal role in predicting the severity of coronary artery disease in patients. The CHA2DS2-VASc and CHADS2 scores have been commonly used for such predictions, but they may benefit from an expanded risk factor profile. This study aimed to improve the validity of the CHA2DS2-VASc score by including new major risk factors of CAD which are hyperlipidemia (H), smoking (S), and family history of CAD (F) and compare it with CHADS2 and CHA2DS2-VASc scores to predict severe CAD in the patients. Methods: This prospective observational study was conducted at the Cardiology Department of Benha Insurance Hospital on 250 patients undergoing invasive coronary angiography. Data collection included medical history, physical examinations, laboratory tests, and echocardiography. The Gensini scoring method was employed to evaluate the severity of CAD. The CHA2DS2-VASc-HSF score was calculated. Patients were classified according to the severity of stenosis into 3 groups. Group A: 131 patients with mild to moderate CAD, Group B: 83 patients with severe CAD, and Group C: 36 patients who didn't show stenosis in angiography. Results: The CHA2DS2-VASc-HSF score is superior to the CHADS2 and CHA2DS2 scores for prediction of severe CAD. The CHA2DS2-VASc-HSF score showed an AUC of 0.789, with a sensitivity of 89% and specificity of 59% at a cut-off value of >3, outperforming the other scores. Conclusions: Incorporating additional risk factors, such as hyperlipidemia, smoking, and family history of CAD, into the CHA2DS2-VASc score (CHA2DS2-VASc-HSF) enhances its predictive accuracy for severe CAD.