Objective: To evaluate the correlation between smoking and types of coronary atherosclerotic plaques using Double-Source Computed Tomography (DSCT) angiography. Methods: Patients who underwent DSCT Coronary Angiography (DSCTCA) at our hospital between April 2012 and April 2013 were enrolled and divided into a smoking group and a nonsmoking group according to their response to a questionnaire of smoking. Patients with a familial genetic history of coronary or concomitant diabetes mellitus, hypertension, or hyperlipidemia were considered and divided into two groups according to their smoking history, as 200 smokers and 200 non-smokers were selected for the study. The incidence rates, distribution characteristics, and types of plaque were identified and compared between the two groups. Results: The incidences of mixed plaques (44.7% vs. 21.9%) and non-calcified plaques (38.7% vs. 67.9%) were significantly different between the smoking group and the non-smoking group (both P <0.05). When the data were adjusted for age, sex, and weight index, smoking was an independent risk factor for formation of mixed plaques. The smoking group was subdivided according to the Smoking Index (SI) and a comparison showed that the incidence of mixed plaques increased with increasing SI. Conclusion: DSCTCA can accurately evaluate differences in coronary atherosclerotic plaques between smokers and non-smokers. Smokers are more likely to develop mixed plaques and are at higher risk of cardiovascular events, and the plaques are distributed more widely.