Aim To investigate the relationship between visceral adipose index (VAI) and lipid accumulation index(LAP) and carotid atherosclerosis (CAS) in high risk stroke patients. Methods The source of the case was 9 215 cases of high risk stroke population screened by 8 community hospitals in Fengtai District, Beijing. Collect complete demographic information and TCM syndrome scale through face-to-face questionnaire survey. Test items included physical examination, blood test and carotid ultrasound examination. The two indexes of VAI and LAP can be calculated by the formula. Statistical methods was used to explore the correlation between various indicators and carotid atherosclerosis, and stratified research was carried out. Results 9 215 subjects (mean age 60±9 years, 61.4% of women) were analyzed. The prevalence of carotid atherosclerosis was 74.7%. The levels of waist circumference, waist to height ratio (WHtR), female VAI, and female LAP was significantly higher in CAS group than those in control group (P＜0.001). Female visceral obesity replacement indexes were significantly correlated with carotid atherosclerosis (P＜0.001). Multivariate Logistic regression showed that age, gender (female), previous stroke history, hypertension, diabetes, smoking, and lack of physical exercise were independent risk factors for CAS in high risk stroke populations. Conclusion High high density lipoprotein cholesterol (HDLC) levels, eating vegetables, and fruits have a protective effect on carotid atherosclerosis. Female visceral obesity is significantly positively correlated with carotid atherosclerosis in stroke populations. The main risk factors affecting the formation of CAS are VAI, age, gender (female), history of previous stroke, hypertension, diabetes, smoking, lack of physical exercise.