Abstract Purpose of this study was the evaluation of the thoracic aortic wall thickness as a potential identifier of patients at increased risk for future cardiac events. Thoracic aortic wall thickness was measured with MDCT in 160 patients. The CT-scans were implemented as non-invasive coronary angiography studies. Relationships between aortic wall thickness, sex, age, major risk factors and atherosclerotic plaque burden of the coronary arteries were explored. Higher values of maximum aortic wall thickness of the descending aorta (women P = 0.02, men P — 0.01) were found in patients with coronary atherosclerosis, compared to patients with same gender but excluded atherosclerosis. Aortic wall thickness of the mid-portion of the descending aorta of 3.0 mm is associated with coronary artery disease (CAD) with a specificity of 96.6% (sensitivity 27.5%) and a positive predictive value (PPV) of 93.3%. For patients with two or more major risk factors and a maximum wall thickness of equal or more than 2.6 mm we found a PPV of 100%. We conclude that measurements of maximum wall thickness of the descending aorta are a potential tool for detecting patients with coronary atherosclerosis. The potential effect of combining measurements of aortic wall thickness at routine chest CT studies with a possible cardiovascular screening is substantial and merits further study.