Traffic is one of the major sources of environmental pollution in metropolitan areas, emitting pollutants such as particulate matter and noise. Epidemiological evidence links both particulate matter (PM) and noise to cardiovascular disease and increased cardiovascular mortality. Short-term exposure to traffic may trigger acute cardiovascular events. Long-term residential traffic exposure is associated with the degree of subclinical atherosclerosis, prevalence of coronary heart disease and incidence of myocardial infarction. This review will present recent epidemiological findings regarding long-term exposure to traffic and its association with coronary heart disease, using results from the Heinz Nixdorf Recall Study, an ongoing prospective cohort study of 4814 unselected participants living in three large adjacent cities of the highly industrialized Ruhr Area in western Germany. Special focus is placed on the association of long-term traffic exposure with subclinical atherosclerosis, the major underlying pathology for cardiovascular disease.