Cardiovascular disease in space: A systematic review

Chayakrit Krittanawong; Ameesh Isath; Scott Kaplin; Hafeez Ul Hassan Virk; Sonya Fogg; Zhen Wang; Marc Shepanek; Richard A Scheuring; Carl J Lavie

doi:10.1016/j.pcad.2023.07.009

Cardiovascular disease in space: A systematic review

Prog Cardiovasc Dis. 2023 Nov-Dec:81:33-41. doi: 10.1016/j.pcad.2023.07.009. Epub 2023 Jul 31.

Authors

Chayakrit Krittanawong¹, Ameesh Isath², Scott Kaplin³, Hafeez Ul Hassan Virk⁴, Sonya Fogg⁵, Zhen Wang⁶, Marc Shepanek⁷, Richard A Scheuring⁸, Carl J Lavie⁹

Affiliations

¹ Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY, USA. Electronic address: chayakrit.krittanawong@va.gov.
² Department of Cardiology, Westchester Medical Centre and New York Medical College, Valhalla, NY, USA.
³ Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY, USA.
⁴ Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH, USA.
⁵ Library and Learning Resource Center, Texas Heart Institute, Houston, USA.
⁶ 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.
⁷ Office of the Chief Health and Medical Officer, NASA, Washington, DC 20546, USA.
⁸ Flight Medicine, NASA Johnson Space Center, Houston, TX 77058, USA.
⁹ John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA.

PMID: 37531984
DOI: 10.1016/j.pcad.2023.07.009

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.

Keywords: Acute myocardial infarction; Cardiovascular disease; Stroke; Systematic review.

Publication types

Systematic Review
Review

MeSH terms

Arrhythmias, Cardiac
Atherosclerosis*
Atrophy
Cardiovascular Diseases* / epidemiology
Cardiovascular Diseases* / etiology
Hemodynamics
Humans
Orthostatic Intolerance*
Prospective Studies
Space Flight*