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Background  Available evidence for the relationship between coffee intake and subclinical atherosclerosis is limited and inconsistent. This study aimed to evaluate the association between coffee consumption and coronary artery calcium ( CAC ) in  ELSA ‐Brasil (Brazilian Longitudinal Study of Adult Health).    Methods and Results  This cross‐sectional study is based on baseline data from participants of the  ELSA ‐Brasil cohort. Only participants living in São Paulo, Brazil, who underwent a  CAC  measurement (n=4426) were included. Coffee consumption was collected using a food frequency questionnaire.  CAC  was detected with computed tomography and expressed as Agatston units.  CAC  was further categorized as an Agatson score ≥100 (CAC ≥100). In multiple logistic regression analysis considering intake of coffee and smoking status interaction, significant inverse associations were observed between coffee consumption (>3 cups/d) and  CAC ≥100 (odds ratio [OR]: 0.85 [95% confidence interval, 0.58–1.24] for ≤1 cup/d;  OR : 0.73 [95% confidence interval, 0.51–1.05] for 1–3 cups/d;  OR : 0.33 [95% confidence interval, 0.17–0.65] for >3 cups/d). Moreover, there was a statistically significant interaction effect for coffee consumption and smoking status ( P =0.028 for interaction). After stratification by smoking status, the analysis revealed a lower  OR  of coronary calcification in never smokers drinking >3 cups/d ( OR : 0.37 [95% confidence interval, 0.15–0.91]), whereas among current and former smokers, the intake of coffee was not significantly associated with coronary calcification.    Conclusions  Habitual consumption of >3 cups/d of coffee decreased odds of subclinical atherosclerosis among never smokers. The consumption of coffee could exert a potential beneficial effect against coronary calcification, particularly in nonsmokers.

Coffee Consumption and Coronary Artery Calcium Score: Cross‐Sectional Results of ELSA‐Brasil (Brazilian Longitudinal Study of Adult Health)