Aim To investigate the relationship between Helicobacter pylori (Hp) infection and plaque characteristics, lipid metabolism and inflammatory response in patients with coronary heart disease. Methods 178 patients with coronary heart disease who were first diagnosed in our hospital from August 2017 to March 2019 were selected as the subjects of study. According to the results of detection of Hp infection, the patients were further divided into 65 cases of Hp positive group and 113 cases of Hp negative group. The differences of coronary angiographic results, carotid ultrasound plaque characteristics, peripheral blood lipid metabolism and serum inflammatory mediators levels were compared between the two groups. Results The results of coronary angiography showed that there were significant differences in the number of coronary artery lesions and the nature of coronary plaque between the two groups (P＜0.05). Gensini score of Hp positive group was higher than that of Hp negative group (P＜0.01). Plaque area of carotid ultrasound, intima-media thickness in Hp positive group were larger than those in Hp negative group (P＜0.01); There was significant difference in plaque nature between the two groups (P＜0.05). The levels of serum total cholesterol and low density lipoprotein cholesterol in Hp positive group were higher than those in Hp negative group, and the level of high density lipoprotein cholesterol was lower than that in Hp negative group (P＜0.01). The serum levels of interleukin-6, interleukin-18, tumor necrosis factor α and high-sensitivity C-reactive protein in Hp positive group were higher than those in Hp negative group (P＜0.05). Conclusion The combination of Hp infection may be one of the important factors leading to the decrease of plaque stability, the increase of lipid metabolism disorder and the aggravation of inflammatory reaction in patients with coronary heart disease.