The Cardiovascular Health Diet Index (CHDI) is a diet quality score based on the dietary guidelines of the American Heart Association for cardiovascular health, but with some adaptations, such as red meat, dairy, beans, and ultra-processed foods in its components. The CHDI has shown good relative validity parameters, however, its association with health outcomes is still unclear. Thus, our aim was to investigate the association between the CHDI score with subclinical atherosclerosis. Data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort were used. Subclinical atherosclerosis was assessed by measuring coronary artery calcification (CAC) at baseline (2008-2010) and second wave (2012-2014) and carotid intima-media thickness (cIMT) at baseline and at the third wave (2017-2019). The CHDI score (ranges from 0 to 110 points) was applied to dietary data obtained from a food frequency questionnaire at baseline. Poisson regression with robust variance, linear regression and linear mixed-effects models were used to evaluate the association of the CHDI score with CAC incidence (n 2,224), CAC progression (n 725), and changes in cIMT (n 7,341) over time, respectively. After a median 8-year follow-up period, a 10-point increase in the CHDI score was associated with a decrease in cIMT of 0.002 mm (95% CI –0.005; –0.001). No association was observed between the CHDI score and CAC incidence and progression after a 4-year follow-up period. Higher scores in the CHDI were prospectively associated with decreased subclinical atherosclerosis after an 8-year follow-up period.