Logistic regression analysis showed that overweight (odds ratio (OR): 1.837, 95% confidence interval (CI): 1.312 -2.573, <i>p</i> < 0.001), smoking (OR: 1.644, 95% CI: 1.066-2.535, <i>p</i> = 0.025), hypertension (OR: 2.240, 95% CI: 1.607-3.122, <i>p</i> < 0.001), dyslipidemia (OR: 1.809, 95% CI: 1.268-2.581, <i>p</i> = 0.001), <i>ALDH2</i> rs671 G/A or A/A genotype (G/A + A/A vs. G/G, OR: 1.579, 95% CI: 1.131-2.203, <i>p</i> = 0.007) were associated with coronary atherosclerosis in T2DM. Here, ALDH2 is linked to coronary atherosclerosis.