BACKGROUND: Evidence regarding the relationships between atherogenic index of plasma (AIP)-related indices and carotid atherosclerosis (CA) is limited. METHODS: A total of 59123 participants from the China Stroke High-risk Population Screening and Intervention Program (CSHPSIP) in Hubei Province, China, from 2017 to 2020 were included in this cross-sectional study. Three indices were developed to assess AIP-related indices: AIP-body mass index (AIP-BMI), AIP-waist circumference (AIP-WC), and AIP-waist-height ratio (AIP -WHtR). RESULTS: Per 1-standard deviation (SD) increase in AIP-BMI (OR = 1.36, 95% CI = 1.31-1.41), AIP-WC (1.34, 1.29-1.38), and AIP-WHtR (1.33, 1.28-1.38) were associated with CIMT. Per 1-standard deviation (SD) increase in AIP-BMI (OR = 1.32, 95% CI = 1.28-1.37), AIP-WC (1.34, 1.29-1.38), and AIP-WHtR (1.33, 1.29-1.38) were associated with plaques. AIP-BMI, AIP-WC and AIP-WHtR were positively associated with stenosis when they were divided into interquartile range (IQR), compared with the Q1 group. The ROC analyses showed that AIP-BMI had the greatest diagnostic value for CA and CIMT, with the AUC of 0.833 (0.828, 0.838) and 0.817 (0.811, 0.824), respectively. AIP-BMI, AIP-WC and AIP-WHtR had the greatest diagnostic value for plaques, with the AUC of 0.842 (0.836, 0.848), 0.842 (0.836, 0.847), and 0.842 (0.836, 0.848), respectively. Meanwhile, all the four indices (AIP, AIP-BMI, AIP-WC and AIP-WHtR) showed the same diagnostic value for plaques, with the AUC of 0.871 (0.858, 0.884). CONCLUSIONS: AIP-related indices were positively associated with CA, carotid intima-media thickness (CIMT), plaque and stenosis. Future prospective studies are needed to confirm our findings and clarify their clinical utility.