•Solid fuel use was positively associated with 10-year ASCVD risk in rural regions.•Synergistic effects between solid fuel use and air pollutants on high 10-year ASCVD risk were found.•Clean fuel use and air pollutants control may jointly alleviate ASCVD's burden. Although exposure to ambient air pollution (AAP) increases the risk for arteriosclerotic cardiovascular disease (ASCVD), evidence on the association of solid fuel use with ASCVD and its association modified by ambient air pollution remains limited. A total of 16,779 adults were derived from the Henan Rural Cohort Study. Concentrations of ambient air pollutants (PM1, PM2.5, PM10, and NO2) were estimated by a spatiotemporal model based on satellites data. Solid fuel use was assessed by a self-reported questionnaire. The associations of solid fuel use with high 10-year ASCVD risk and the modified association by exposure to air pollutants were explored using logistic regression models. There were positive associations of AAP exposure with high 10-year ASCVD risk among individuals with self-cooking. The joint associations between high AAP exposures and solid fuel use with high 10-year ASCVD risk were found. Compared to clean fuel user with low PM2.5 exposure, the odds ratios (ORs) and 95% confidence intervals (CIs) of high 10-year ASCVD risk was 1.25 (1.09, 1.42) for solid fuel user with low PM2.5 exposure, 1.93 (1.75, 2.12) for clean fuel user with high PM2.5 exposure, and 3.08 (2.67, 3.54) for solid fuel user with high PM2.5 exposure, respectively. Their additive effect on high 10-year ASCVD risk was observed (relative excess risk due to interaction (RERI): 0.90 (95 %CI: 0.50, 1.30), attributable proportion due to interaction (AP): 0.29 (95 %CI: 0.19, 0.40), and synergy index (SI): 1.77 (95 %CI: 1.38, 2.26)). This study showed a synergistic effect of AAP and household air pollution reflected by solid fuel use on high 10-year ASCVD risk, suggesting that reducing solid cooking fuels and controlling air pollution may have a joint effect on public health improvement.