Objective To explore the risk factors related to coronary heart disease (CHD) complicated with carotid plaque, and compare the effects of different lipid-lowering treatment schemes on carotid plaque. Methods The data of 335 patients with CHD, hospitalized in the Department of Cardiology of Wuhan First Hospital and undergone coronary angiography and percutaneous coronary intervention (PCI) from January 2017 to December 2019, were collected and analyzed retrospectively. The biochemical indexes of CHD with carotid plaque group (n=257) and CHD without carotid plaque group (n=78) were compared,and the factors affecting the distribution of blood lipid levels were screened and analyzed in the CHD with carotid plaque group. Univariate and multivariate logistic regression were performed to analyze the risk factors of CHD complicated with carotid plaque.Then the patients in CHD complicated with carotid plaque group were divided into four subgroups according to the actual oral lipid-lowering drug regimen: atorvastatin 20 mg group (n=90), atorvastatin 10 mg + ezetimibe 10 mg group (n=51), rosuvastatin 10 mg group (n=71), and pivastatin 2 mg group (n=36). The number and size changes of carotid plaques were analyzed before and one year after PCI. Results The BMI, blood pressure (including systolic pressure and diastolic pressure), serum creatinine and uric acid levels, low density lipoprotein cholesterol (LDL-C) and total cholesterol (TC), glycosylated hemoglobin (HbA_1c) and lipoprotein phospholipase A₂ (Lp-PLA2) increased obviously in CHD complicated with carotid plaque group compared with without carotid plaque group (P<0.01). In patients with CHD complicated with carotid plaque, gender, age and BMI were the factors affecting blood lipid levels (P<0.05). The results of univariate and multivariate logistic regression analysis showed that HbA_1c, Lp-PLA2,LDL-C, creatinine, albumin and uric acid were the risk factors affecting carotid plaque (P<0.05). The number and/or size decreased of carotid plaques could be reduced by different lipid-lowering treatment schemes one year after PCI in the four subgroups, but there was no significant difference between the groups. Conclusions Biochemical indicators such as HbA_1c, Lp-PLA2, LDL-C,creatinine, albumin and uric acid can be used for screening and targeted prevention and treatment of high-risk population. Different lipid-lowering treatment schemes have no significant effect on carotid plaque.