South Asians in the Western world have a high prevalence of diabetes mellitus (DM) and an increased risk of coronary artery disease (CAD) and mortality compared with Caucasians. CAD in asymptomatic South Asian patients with type 2 DM has not been investigated. The aim of this observational cohort study was to investigate CAD in asymptomatic South Asian patients with type 2 DM and to compare with matched Caucasian patients. A total of 120 asymptomatic South Asian patients with type 2 DM and matched Caucasian patients (mean age 52 years, 55% men) were derived from an ongoing registry of cardiovascular risk stratification in asymptomatic patients with DM. Cardiovascular risk assessment included multidetector row coronary computed tomography angiography. CAD was assessed as the coronary artery calcium score and classified into no signs of atherosclerosis or minor wall irregularities <30%, nonsignificant CAD 30% to 50%, or significant CAD ≥50% stenosis. On a patient base, CAD was scored according to the severity and number of vessels and segments with significant CAD. Subsequently, CAD was assessed per coronary artery and per segment. Compared with Caucasian patients, South Asian patients had a significantly higher coronary artery calcium score and higher prevalence of significant CAD (41% vs 28%, respectively, p = 0.008), involving more coronary vessels and segments. Significant CAD was especially more frequent in the left anterior descending coronary artery. In conclusion, asymptomatic South Asian patients with type 2 DM have a higher prevalence and extent of CAD compared with matched Caucasian patients.