Opportunistic Cardiovascular Assessment During Lung Cancer Screening with Low-Dose Computed Tomography: A New Window for Prevention

Population-based lung cancer screening with low-dose computed tomography (LDCT) is expanding across Europe, including a publicly funded Polish programme starting in October 2026. Because screening-eligible individuals share substantial tobacco-related cardiovascular risk, LDCT also offers cardiovascular risk assessment without additional radiation. We conducted a narrative review of the PubMed literature published up to September 2026, prioritising guidelines, lung cancer screening cohorts and systematic reviews. We summarise the cardiovascular findings on non-contrast, non-electrocardiography (ECG)-gated LDCT: coronary artery, aortic valve, mitral annular and thoracic aortic calcification, ascending aortic dilatation, pericardial effusion, and pulmonary artery enlargement, as well as investigational cardiac volumetry, epicardial adipose tissue and artificial intelligence (AI)-assisted quantification. We grade each finding by reportability, defined downstream action and supporting evidence, and align reporting thresholds with the European Respiratory Society/European Society of Thoracic Imaging (ERS/ESTI) statement on incidental findings. LDCT cannot replace dedicated cardiac imaging or establish haemodynamic diagnoses. The prognostic value of coronary and aortic valve calcification and of ascending aortic dilatation is established, whereas the evidence for mitral annular calcification and pulmonary artery enlargement is more limited; observational data indicate that reporting these markers changes preventive management, but whether this improves cardiovascular outcomes has not yet been demonstrated. Standardised reporting, proportionate thresholds, and coordinated pathways linking radiology, pulmonology, primary care and cardiology are needed to translate incidental cardiovascular findings into scalable prevention and should be evaluated in implementation studies.