Objective To explore the application value of ultrafast pulse wave velocity (UFPWV) technique in evaluating carotid atherosclerosis in patients with coronary heart disease and angina pectoris. Methods A total of 64 patients with coronary heart disease and angina pectoris who were treated in The First Affiliated Hospital, Heilongjiang University of Traditional Chinese Medicine from Jun. 2020 to Jun. 2021 were selected. According to the type of angina pectoris, they were divided into stable group (stable angina pectoris, n=34) and unstable group (unstable angina pectoris, n=30); 30 healthy volunteers in the same period were selected as healthy control group. The general data of patients were collected. Common carotid intima-media thickness (IMT) and left ventricular ejection fraction were recorded by two-dimensional gray-scale ultrasound; pulse wave velocity in beginning of systole (PWV-BS) and pulse wave velocity in ending of systole (PWV-ES) were detected by UFPWV technique; and the levels of arteriosclerosis index matrix metalloproteinase 3 (MMP-3) and proteinase K were detected by enzyme-linked immunosorbent assay. Results The smoking history, systolic blood pressure and common carotid IMT in the stable and unstable groups were significantly higher than those in the control group (all P<0.05); the common carotid PWV-BS and PWV-ES in patients with angina pectoris (in the stable and unstable groups) were significantly higher than those in the control group (both P<0.001); the common carotid PWV-ES and the levels of serum MMP-3 and proteinase K in the unstable group were significantly higher than those in the stable group (all P<0.05); and with the median value of PWV-ES as the cut-off value, the levels of serum MMP-3 and proteinase K in the high PWV-ES level group were significantly higher than those in the low PWV-ES level group (both P<0.01). Conclusion PWV-ES measured by UFPWV technique can be used to assess the risk of carotid atherosclerosis in patients with coronary heart disease and angina pectoris, which is worthy of popularization and application.