Background: Visceral adiposity index (VAI) is a mathematical model that uses simple anthropometric and functional parameters, proposed to reflect visceral adiposity and insulin resistance. Recent studies report the association of VAI with cardiovascular events. We analyzed the association of VAI with coronary artery calcium score (CACS) in Korean adults. Methods: In 33,468 participants in a health screening program, VAI was calculated with the following formula: [waist circumference (WC)/{36.58＋(1.89 * body mass index (BMI))}] * (triglyceride/0.81) * (1.52/HDL-C). Coronary artery calcium score was measured with multi-detector computed tomography. Other metabolic parameters were measured. Results: Mean age of the subjects was 42 years old. Age, BMI, blood pressure, WC, fasting blood glucose, insulin, lipid profiles showed positive correlation, and HDL-C showed negative correlation with VAI. CACS showed positive correlation with VAI (r＝0.027, p＜0.01). Subjects with CACS＞0 had worse metabolic parameters compared as subjects with CACS＝0. Subjects with CACS＞0 showed significantly higher VAI compared as those with CACS＝0 (2.05±1.92 vs. 1.68±1.50, p＜0.01). In logistic regression analyses with CACS＞0 as the dependent variable, the highest tertile of VAI (＞1.777) showed significantly increased odds ratio for CACS＞0 compared with the lowest tertile (＜0.967) even after adjustment for confounding variables {1.160 (1.015-1.327)}. Conclusions: The subjects with high VAI showed increased risk for subclinical atherosclerosis assessed by CACS.