Angular contact ball bearings are common basic components in rotating machinery. During the operation of the bearing, the rolling slips, resulting in contact sliding friction between it and the raceway, which in turn causes wear in the rolling element and increase in the radial clearance of the bearing. The increase in clearance also affects the stiffness of the bearing, which in turn affects the natural frequency and fatigue life of the bearing. At present, there are few studies on the influence of bearing wear (variation of clearance) on life. In this paper, the finite element model based on the theory of contact mechanics is established for the angular contact ball bearing with medium- and high-speed rotation, and the mechanical properties and fatigue life influenced by the internal action of the bearing are analyzed. The effects of radial load and deflection angle on the mechanical properties and fatigue life of the bearing are also studied. Based on the analysis results of bearing contact mechanical properties and clearance changes, the calculation method of bearing life under rolling element wear is established. The influence of the variation of clearance and preload clearance on bearing life is analyzed, and the optimal preload is obtained. The research results of this paper can provide a theoretical basis for optimizing the installation of angular contact ball bearings, reasonably determining the service conditions, and prolonging the service life of bearings, which is necessary for engineering practice.