OBJECTIVE: To investigate the influence of Helicobacter pylori (HP) infection on carotid atherosclerosis (AS) in the physical examination population. METHODS: This study included physical examination patients from the First Affiliated Hospital of Xinjiang Medical University (May 2021-May 2023). Participants underwent a carbon-13 urea breath test (13C-UBT), HP antibody detection, and carotid AS assessment via colour Doppler ultrasound. The patients were divided into the HP-infected group and the non-infected group based on 13C-UBT results, with the HP-infected group further subdivided into high-risk and low-risk groups based on antibody detection. General data, laboratory indexes and carotid AS indexes were compared between the groups. Multivariate logistic regression was used to analyse carotid plaque (CP) formation risk factors. RESULTS: The HP-infected group showed significantly higher body mass index levels, low-density lipoprotein cholesterol (LDL-C), and serum uric acid levels than the non-infected group (p <
0.05). The high-risk group demonstrated significant age differences, body mass index, hypertension, total cholesterol, LDL-C, and blood uric acid levels compared with the low-risk group (p <
0.05). Logistic regression identified age, smoking, systolic blood pressure and glycosylated haemoglobin as CP formation factors between the infected and non-infected groups (p <
0.05). Between the high-risk and low-risk groups, age, smoking, diabetes, systolic blood pressure and high-risk HP were identified as CP formation factors (p <
0.05). CONCLUSIONS: Helicobacter pylori infection, particularly high-risk HP infection, advances carotid AS in the physical examination population, with high-risk HP infection serving as a risk factor for CP formation.