Aim To evaluate the relationship between diabetic retinopathy （DR） and subclinical coronary atherosclerosis （CAs） on coronary 64-slice multidetector computed tomography angiography （MDCT） in individuals with type 2 diabetes mellitus. Methods From July 2007 to December 2009, 114 and 124 type 2 diabetic patients with and without CAs were enrolled. They received fundus photochromy, coronary 64-slice multidetector computed tomography angiography, physical examination, and measurement of fasting plasma glucose（FPG）, glycosylated haemoglobin （HbA1c）, plasma lipid profile, estimated glomerular filtration rate （eGFR） and urinary albumin excretion rate（UAER）. Then the analysis of the relationship among the detection and measurement outcomes were conducted. Results Diabetic patients with CAs had a higher prevalence of DR than those without CAs （67.5% vs 33.1%, P<0.001）. After adjustment for the traditional risk factors for cardiovascular disease, CAs was independently associated with DR （OR5.0, 95%CI 2.6～9.8）. There was significant difference in the prevalence of CAs by the number of CAs vessels among patients without DR （NDR）, those with pre-proliferative retinopathy （pre-PDR） and those with proliferative retinopathy （PDR） （P<0.01）. The prevalences for CAs, the prevalences of CAs ≥3 vessels involved by plaque, and proportions of vessels with significant coronary plaque and of involved vessels in all detected coronary arteries were significantly increased with the presence and severity of DR （NDR vs Pre-PDR, Pre-PDR vs PDR, P<0.01 for each）. Conclusions The severity and extent of CAs were significantly increased with the incidence and progression of DR, and much of CAs and DR could be still multifactoral with common pathway.