Cardiovascular risks and hazards associated with deep space exploration

Space flight exposes astronauts to a unique environment characterized by microgravity, ionizing radiation, and other stressors that can profoundly affect the human body. Deep-space exploration-type missions to the Moon (NASA’s Artemis and Gateway programs), Mars, and beyond will introduce prolonged exposure to health hazards, including but not limited to isolation and confinement, sleep disruption, and exposure to different types and quantities of particle radiation (i.e., high-energy and atomic number – HZE). There are also logistical implications of traveling farther from low Earth orbit (LEO), including limited access to medical help and supplies. Currently, the known effects of space travel on the cardiovascular system include dysrhythmias, altered vascular compliance, dysautonomia, and induction of a pro-inflammatory state. It is not known how these concerns, and other potentially unknown cardiovascular risks, will manifest during and/or after exploration-type missions. This manuscript comprehensively reviews the cardiovascular disease risks associated with deep space exploration. Brojakowska et al. review the synergistic cardiovascular risks of deep-space travel, from HZE radiation to microgravity-induced remodeling. By integrating murine mechanistic data with probabilistic modeling, the authors advocate for a shift toward individualized, Earth-independent medical frameworks to safeguard astronauts on multi-year missions.