Cardiovascular disease in space: A systematic review

Authors

Chayakrit Krittanawong, Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY, USA. Electronic address: chayakrit.krittanawong@va.gov.
Ameesh Isath, Department of Cardiology, Westchester Medical Centre and New York Medical College, Valhalla, NY, USA.
Scott Kaplin, Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY, USA.
Hafeez Ul Virk, Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH, USA.
Sonya Fogg, Library and Learning Resource Center, Texas Heart Institute, Houston, USA.
Zhen Wang, Mayo Clinic Evidence-based Practice Center, Rochester, MN, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
Marc Shepanek, Office of the Chief Health and Medical Officer, NASA, Washington, DC 20546, USA.
Richard A. Scheuring, Flight Medicine, NASA Johnson Space Center, Houston, TX 77058, USA.
Carl J. Lavie, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA.

Author Type(s)

Resident/Fellow

DOI

10.1016/j.pcad.2023.07.009

Journal Title

Progress in Cardiovascular Diseases

First Page

33

Last Page

41

Document Type

Article

Publication Date

1-1-2023

Department

Medicine

Abstract

BACKGROUND: With expanding commercial space programs, uncertainty remains about the cardiovascular effects of space environmental exposures including microgravity, confinement, isolation, space radiation, and altered bacterial virulence. Current limited data suggests additional health threats compared to Earth. METHODS: We systematically reviewed PubMed, CENTRAL, Web of Science, EMBASE and Cochrane databases for prospective studies on spaceflight and cardiovascular outcomes. Search terms combined cardiovascular disease topics with spaceflight concepts. No date or language restrictions were imposed. RESULTS: 35 studies representing 2696 space travelers met inclusion criteria. Studies were grouped into spaceflight associations with: atherosclerosis, mortality, cardiac function, orthostatic intolerance, and arrhythmias. Atherosclerosis evidence was limited, with animal studies linking space radiation to endothelial damage, oxidative stress, and inflammation. However, human data showed no significantly increased atherosclerotic disease in astronauts. Mortality studies demonstrated lower cardiovascular mortality in astronauts compared to the general population however there was conflicting data. Cardiac function studies revealed physiologic ventricular atrophy, increased arterial stiffness, and altered blood flow distribution attributed to microgravity exposure. Effects appeared transient and reversible post-flight. Orthostatic intolerance studies found astronauts experienced altered heart rate variability, baroreflex response, and blood pressure changes post-flight. Arrhythmia studies showed increased ventricular ectopy during spaceflight, but limited data on long term flights. CONCLUSIONS: Environmental space hazards impact the cardiovascular system through multiple mechanisms. Microgravity causes cardiac atrophy and orthostatic intolerance while space radiation may potentially accelerate atherosclerosis. Further research is needed, especially regarding long-term spaceflights.

Recommended Citation

Krittanawong, C., Isath, A., Kaplin, S., Virk, H. U., Fogg, S., Wang, Z., Shepanek, M., Scheuring, R. A., & Lavie, C. J. (2023). Cardiovascular disease in space: A systematic review. Progress in Cardiovascular Diseases, 81, 33-41. https://doi.org/10.1016/j.pcad.2023.07.009