BACKGROUND: It is well established that coronary artery disease progresses along with myocardial disease. However, data on the association between coronary artery calcium (CAC) and echocardiographic variables are lacking. METHODS AND RESULTS: Among 2,650 Framingham Study participants (mean age 51 yrs, 48% women; 40% with CAC > 0), we related CT-based CAC score to left ventricular (LV) mass index (LVMi), LV ejection fraction (LVEF), E/e', global longitudinal strain (GLS), left atrial emptying fraction (LAEF), and aortic root diameter (AoR), using multivariable-adjusted generalized linear models. CAC score (independent variable) was used as log-transformed continuous [ln(CAC+1)] and as a categorical (0, 1-100, and > /=101) variable. Adjusting for standard risk factors, higher CAC score was associated with higher LVMi and AoR (betaLVMI per 1-SD increase 0.012, betaAoR 0.008; P < 0.05, for both). Participants with 1 < /=CAC < /=100 and those with CAC > /=101 had higher AoR (betaAoR 0.013 and 0.020, respectively, P = 0.01) than those with CAC = 0. CAC score was not significantly associated with LVEF, E/e', GLS or LAEF. Age modified the association of CAC score with AoR; higher CAC scores were associated with larger AoR more strongly in older ( > 58 years; betaAoR0.0042;P < 0.007) than in younger ( < /=58 years) participants (betaAoR0.0027;P < 0.03). CONCLUSIONS: We observed that subclinical atherosclerosis was associated with ventricular and aortic remodeling. The prognostic significance of these associations warrants evaluation in additional mechanistic studies.