Objective: To define the risk of coronary artery disease (CAD) in adults with a history of juvenile arthritis (JA). Methods: We used the National Health and Nutrition Examination 2007–2014 surveys. Two comparison groups were identified: a random sample of patients without arthritis, and respondents with reported having rheumatoid arthritis (RA). CAD was defined as a “yes” response to the survey question, “Have you ever been told you had congestive heart failure, coronary heart disease, angina/angina pectoris, heart attack, or stroke?” Potential confounders for CAD included age, sex, race, smoking status, and any component of metabolic syndrome. Results: A total of 232 respondents reported having JA. We randomly selected 1,028 without arthritis and 1,105 who reported having RA. In simple logistic regression, the JA group had a 3-fold increased odds of CAD compared to those without arthritis (odds ratio [OR] 3.2 [95% confidence interval (95% CI) 2.1–4.8], P < 0.0001). Controlling for confounders, the odds of CAD in JA continued to be increased (OR 4.2 [95% CI 4.7–10.5], P = 0.002). When comparing the JA and RA groups, in simple logistic regression, the JA group had a lower odds of CAD (OR 0.7 [95% CI 0.5–0.9], P = 0.03). Controlling for confounders, there was no significant difference in the odds of CAD between groups (OR 0.8 [95% CI 0.5–1.3], P = 0.4). Conclusion: Adults with a history of JA have a higher risk of CAD compared to adults without arthritis. Providers should be aware of the increased risk of CAD in adults with JA and aggressively screen these patients for modifiable risk factors.