Objective To investigate the characteristics of ST segment changes in middle-aged and elderly people in Fuzhou through cardiopulmonary exercise test and to analyze its possible influencing factors, in order to provide theoretical guidance for cardiovascular prevention. Methods A total of 987 individuals undergoing health examination at the physical examination center of 900TH Hospital of Joint Logistics Support Force from 2017 to 2023 were collected as study subjects, and cardiopulmonary exercise tests were performed, and the exercise maximum heart rate (/min), resting systolic blood pressure (mm Hg), resting diastolic blood pressure (mm Hg), peak systolic blood pressure (mm Hg),，carbon dioxide ventilation equivalent (%) ，Borg score (score) and other index data were collected, using Logistic regression to analyze the influencing factors of ST segment anomalies. Results A total of 234 ST-segment abnormalities occurred, and the abnormal rate was 23.72%. Among them, 148 cases (14.99%) were depressed in ST segment, 52 cases (5.27%) were elevated in ST segment, 13 cases (1.32%)was extended in ST segment , and 21 cases (2.14%) was shortened in ST segment . The ST-segment abnormal group had higher exercise maximum heart rate (/min), resting systolic blood pressure (mm Hg), resting diastolic blood pressure (mm Hg), peak systolic blood pressure (mm Hg), peak diastolic blood pressure (mm Hg), carbon dioxide ventilation equivalent (%) and Borg score (score) than the normal group, and the differences were statistically significant. The results of multivariate regression analysis showed that peak systolic blood pressure (mm Hg), carbon dioxide ventilation equivalent (%) and Borg score (score) were the influencing factors in the ST segment depression ; the peak systolic blood pressure (mm Hg) and Borg score (score) were the influencing factors in the ST segment elevation(OR>1). Conclusion Peak systolic blood pressure (mm Hg), carbon dioxide ventilation equivalent (%) and Borg score (score) are the influencing factors of ST segment abnormalities in cardiopulmonary exercise test in middle-aged and elderly people , and their measurement is of great significance for cardiovascular health evaluation and treatment.