Abstract
Objectives
To explore how participants in the UK’s Targeted Lung Health Check (TLHC) programme understand and respond to incidental findings of coronary artery calcification (CAC), and to identify patient preferences for communication that might enhance engagement with cardiovascular prevention such as lipid-lowering therapy (LLT).
Design
Qualitative study using semi-structured interviews and thematic analysis.
Setting
One general practice participating in the NHS TLHC programme in North-East England, an area of high social deprivation.

Participants
Ten adults aged 59–71 years with CAC detected on TLHC CT scans and a calculated Qrisk > 10%.

Primary outcome
To explore patient understanding of incidental CAC findings and how this influences engagement with cardiovascular prevention.
Secondary outcomes
To identify patient preferences for receiving and discussing CAC results, including preferred communication methods, terminology, and the role of the clinician in shaping preventive treatment decisions.

Results: Patients initially reported understanding their findings, but deeper exploration revealed misconceptions about personal CVD risk. A lack of trust in doctors and reliance on non-clinical information sources (social media, family, friends) were barriers to LLT uptake. Trust in the medical professional giving the advice also shaped acceptance of LLT.

Conclusions: Enhancing patient education on CAC findings, fostering doctor-patient trust, and tailoring communication strategies may improve LLT uptake. Personalised follow-up and clearer risk explanations could reduce hesitancy and improve engagement with preventive care.