Historical records of eight heavy metals (HMs: Cu, Zn, Cr, Ni, Pb, As, Hg and Cd) were analyzed in two dated sediment cores collected from the coastal East China Sea (Meishan Bay, MSB) to investigate the influence of anthropogenic activities on estuary sediment from 1972 to 2019. The sedimentary records of HMs in the two cores reflected the development of economy and change of energy consumption in China's east coastal areas. The contents of most HMs in sediments had no change or showed a downward trend before the 1980s. After the 1980s, the contents of HMs showed an increasing trend, mainly because of the rapid development of aquaculture, industry, and agriculture. The distribution of HMs outside the bay (OB) was mainly affected by industry, shipping, and agriculture (vegetable planting), while HMs in sediments inside the bay (IB) was affected by shipping, agriculture, and aquaculture. Principle component analysis (PCA) showed that Cd, Cr, and Ni could be attributed to industrial discharge, while As, Cu, Pb, and Zn were associated with shipping, agriculture, and aquaculture. Sediments were slightly polluted with Cd (I_geo:0.10–0.71, CF:1.90–7.74) and Ni (I_geo:0.08–0.92, CF:1.25–12.55), and seriously polluted with Hg (I_geo:0.95–1.76, CF:13.43–85.65). This study provides insights for the local governments to raise awareness of HM pollution in the coastal East China Sea and formulate corresponding pollution control measures.