The main risk to people directly exposed to low doses of ionising radiation is usually assumed to be cancer. Various other effects (so called deterministic or tissue reaction effects) are seen with exposure to high doses of radiation, such as in patients treated with radiotherapy. In particular, various types of damage occur to the structures of the heart and to the coronary, carotid, and other large arteries.1 This damage is mainly caused by injury to the microvasculature, partly as a result of excessive cell killing (for example, of capillary cells) and the pro-inflammatory response to such damage, which leads to myocardial and other ischaemia.1

Evidence that an excess risk of cardiovascular disease occurs a long time after exposure to lower doses of radiation has emerged from the Japanese atomic bomb survivor Life Span Study (LSS) …