- Previously, we proposed a hypothesis that chronic helminthic infection may have beneficial effects on the development of atherosclerosis. The aim of this study was to investigate an association between Opisthorchis felineus chronic helminthic infections with aortic atherosclerosis and serum total cholesterol. A series of medico-legal autopsy specimens collected in Khanty-Mansiisk (the region in Russia endemic for O. felineus) were studied to assess O. felineus worm burden in cadaver livers. The areas of atherosclerotic lesions in the cadaver aortas were measured by visual planimetry. A family history of cardiovascular disease, smoking, hypertension or diabetes was elicited, and serum total cholesterol levels examined. Three hundred and nineteen cadavers (280 (87.8%) males and 39 (12.2%) females) aged 20–72 years were divided into five age groups: (i) 20–29, (ii) 30–39, (iii) 40–49, (iv) 50–59 and (v) >60 years old. The O. felineus mean worm burden was 257 ± 312 worms/liver. Infected subjects were categorised into three subgroups depending on the worm burden: mild (<100 worms), moderate (100–500 worms) and severe (>500 worms). Infected subjects had lower serum total cholesterol (mild worm burden, 186.4 ± 25.6 mg/dl; moderate worm burden, 183.4 ± 23.1 mg/dl, P = 0.002; severe worm burden, 170.6 ± 25.1 mg/dl, P < 0.001) than non-infected subjects (201.1 ± 21.2 mg/dl). The average percentage of aortic surface covered by fatty streaks, fibrotic plaques and complicated lesions was negatively related to worm burden in the infected subjects. Chronic helminthic infections was a negative predictor of aortic atherosclerosis; with an odds ratio of 1.72 (1.02–2.91), P = 0.041 for all subjects; and 3.19 (1.35–7.58), P = 0.008 for subjects aged >40 years old. Opisthorchis felineus chronic helminthic infectionswas found to be associated with lower serum total cholesterol levels and a significant attenuation of atherosclerosis.