Abstract: This article reviews the current research status of radiation-induced heart disease (RIHD) resulting from radiotherapy for lung cancer. It systematically reviews the impact of dose-volume parameters of cardiac substructures and RIHD on patient survival rates, and analyzes the reasons why dose constraints for cardiac substructures remain unclear as well as the lack of consensus in existing guidelines regarding dose constraints for cardiac substructures. Moreover, the article discusses the trend toward increasingly refined imaging identification and dose assessment of cardiac substructures, driven by technological advances such as artificial intelligence-based auto-segmentation and nuclear technology applications, along with the new insights emerging from these developments. The authors summarize existing evidence on RIHD after lung cancer radiotherapy, with a focus on the association between cardiac substructure dose parameters and clinical outcomes. Strategies for preventing and managing RIHD are proposed, and new directions for future clinical research are suggested.