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• 80-kVp and DLIR algorithm reduces 45% of radiation dose and 43% contrast dose in CCTA for overweight patients. • CCTA of overweight patients acquired at 1 mSv and 34 mL through the combination of 80-kVp and DLIR algorithm. • DLIR algorithm shows higher capacity of significantly reducing image noise and improving image quality in CCTA. To investigate the use of an 80-kVp tube voltage combined with a deep learning image reconstruction (DLIR) algorithm in coronary CT angiography (CCTA) for overweight patients to reduce radiation and contrast doses in comparison with the 120-kVp protocol and adaptive statistical iterative reconstruction (ASIR-V). One hundred consecutive CCTA patients were prospectively enrolled and randomly divided into a low-dose group (n = 50) with 80-kVp, smart mA for noise index (NI) of 36 HU, contrast dose rate of 18 mgI/kg/s and DLIR and 60 % ASIR-V and a standard-dose group (n = 50) with 120-kVp, smart mA for NI of 25 HU, contrast dose rate of 32 mgI/kg/s and 60 % ASIR-V. The radiation and contrast dose, subjective image quality score, attenuation values, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were compared. The low-dose group achieved a significant reduction in the effective radiation dose (1.01 ± 0.45 mSv vs 1.85 ± 0.40 mSv, P < 0.001) and contrast dose (33.69 ± 3.87 mL vs 59.11 ± 5.60 mL, P < 0.001) compared to the standard-dose group. The low-dose group with DLIR presented similar enhancement but lower noise, higher SNR and CNR and higher subjective quality scores than the standard-dose group. Moreover, the same patient comparison in the low-dose group between different reconstructions showed that DLIR images had slightly and consistently higher CT values in small vessels, indicating better defined vessels, much lower image noise, higher SNR and CNR and higher subjective quality scores than ASIR-V images (all P < 0.001). The application of 80-kVp and DLIR allows for significant radiation and dose reduction while further improving image quality in CCTA for overweight patients. [ABSTRACT FROM AUTHOR]