Although coronary atherosclerosis is an important contributor to cardiovascular burden in adult cancer survivors, it remains unclear as to who is at risk. This systematic review sought to identify the incidence rate of coronary atherosclerosis in different cancer types and risk factors that contributed to the risk difference. A search of papers on the prevalence of coronary atherosclerosis among cancer survivors was conducted on 14^th October 2024. The outcome was to compare the risk of coronary atherosclerosis between survivors from specific cancer types and the general population. Final output was reported as risk difference (RD). In 18 studies (8,099,752 individuals with cancer history), coronary atherosclerosis was assessed through medical records or confirmation on imaging. Compared to the non-cancer population, survivors of hematological, renal and testicular cancer were more likely to be diagnosed with coronary atherosclerosis. In addition, survivors had a significant increase in coronary atherosclerosis risk (absolute risk for survivors vs controls: 17% vs 8%; RD: 0.12 [95% CI: 0.03-0.22], p<0.001) over a longer follow-up period (>10 years). Among cardiovascular risk factors, hypercholesterolemia (β=0.012, p<0.001), hypertension (β=0.008, p=0.017) and obesity (β=0.008, p=0.021) were significant contributors to the risk difference in coronary atherosclerosis development. A lack of treatment data limits the potential to elucidate the impact of therapy on coronary atherosclerosis development among cancer survivors. Overall, the risks of bias of the included studies were low, and no evidence of publication bias was found. Cancer survivors are at an increased risk of developing coronary atherosclerosis compared to the non-cancer population, especially over a longer follow-up period. Future studies should investigate contributors to coronary atherosclerosis, particularly cancer treatments such as chest radiotherapy and immune checkpoint inhibitors, among cancer survivors. This information could guide screening strategies and allow early initiation of treatment to prevent coronary atherosclerosis progression.