OBJECTIVE We evaluated the relationship between intraocular pressure (IOP) and the risk of coronary artery calcification as a predictable marker of cardiovascular disease (CVD) in a large study of asymptomatic men and women. METHODS A cross-sectional study was performed in 10 732 asymptomatic men and women without diagnosed CVD or glaucoma. Coronary artery calcium (CAC) was measured by cardiac CT. The IOPs of all participants were measured by experienced nurses with a non-contact tonometer and automatic air puff control. Logistic regression was used to estimate the OR (95% CI) for the presence of CAC (score >0) with IOP quartiles. RESULTS The prevalence of detectable CAC was 13.7% in men and 4.3% in women. Increasing levels of right IOP were significantly associated with an increased prevalence of CAC. After adjusting for age, sex, smoking, alcohol intake, physical activity, body mass index, educational level, centre, family history of CVD, use of dyslipidaemia medication, diabetes, hypertension, total cholesterol, high density lipoprotein cholesterol and triglycerides, the ORs for CAC score >0, comparing 2-4 quartiles of the right IOP to the lowest quartiles, were 1.32 (95% CI 1.09 to 1.59), 1.20 (95% CI 0.98 to 1.46), and 1.28 (95% CI 1.05 to 1.56), respectively. These associations did not differ by clinically relevant subgroups. CONCLUSIONS A higher IOP is significantly associated with the presence of CAC regardless of conventional cardiovascular risk factors. The present study provides more insight into understanding the process of subclinical atherosclerosis in CVD and the relationship with a higher IOP as a common pathophysiology.