Huff Janice L, Plante Ianik, Blattnig Steve R, Norman Ryan B, Little Mark P, Khera Amit, Simonsen Lisa C, Patel Zarana S
National Aeronautics and Space Administration, Langley Research Center, Hampton, VA, United States.
KBR, Houston, TX, United States.
Front Cardiovasc Med. 2022 May 19;9:873597. doi: 10.3389/fcvm.2022.873597. eCollection 2022.
NASA has recently completed several long-duration missions to the International Space Station and is solidifying plans to return to the Moon, with an eye toward Mars and beyond. As NASA pushes the boundaries of human space exploration, the hazards of spaceflight, including space radiation, levy an increasing burden on astronaut health and performance. The cardiovascular system may be especially vulnerable due to the combined impacts of space radiation exposure, lack of gravity, and other spaceflight hazards. On Earth, the risk for cardiovascular disease (CVD) following moderate to high radiation doses is well-established from clinical, environmental, and occupational exposures (largely from gamma- and x-rays). Less is known about CVD risks associated with high-energy charged ions found in space and increasingly used in radiotherapy applications on Earth, making this a critical area of investigation for occupational radiation protection. Assessing CVD risk is complicated by its multifactorial nature, where an individual's risk is strongly influenced by factors such as family history, blood pressure, and lipid profiles. These known risk factors provide the basis for development of a variety of clinical risk prediction models (CPMs) that inform the likelihood of medical outcomes over a defined period. These tools improve clinical decision-making, personalize care, and support primary prevention of CVD. They may also be useful for individualizing risk estimates for CVD following radiation exposure both in the clinic and in space. In this review, we summarize unique aspects of radiation risk assessment for astronauts, and we evaluate the most widely used CVD CPMs for their use in NASA radiation risk assessment applications. We describe a comprehensive dual-use risk assessment framework that supports both clinical care and operational management of space radiation health risks using quantitative metrics. This approach is a first step in using personalized medicine for radiation risk assessment to support safe and productive spaceflight and long-term quality of life for NASA astronauts.
美国国家航空航天局（NASA）最近完成了几次前往国际空间站的长期任务，并正在巩固重返月球的计划，同时着眼于火星及更远的目标。随着NASA拓展人类太空探索的边界，太空飞行的危害，包括太空辐射，给宇航员的健康和表现带来了越来越大的负担。由于太空辐射暴露、失重以及其他太空飞行危害的综合影响，心血管系统可能特别脆弱。在地球上，从中度到高辐射剂量后心血管疾病（CVD）的风险已从临床、环境和职业暴露（主要来自伽马射线和X射线）中得到充分证实。对于与太空中发现的高能带电离子相关的CVD风险了解较少，而这些离子在地球上的放射治疗应用中越来越多地被使用，这使得这成为职业辐射防护的一个关键研究领域。评估CVD风险因其多因素性质而变得复杂，个体风险受到家族病史、血压和血脂谱等因素的强烈影响。这些已知的风险因素为开发各种临床风险预测模型（CPM）提供了基础，这些模型可告知在特定时期内医疗结果的可能性。这些工具改善了临床决策、使护理个性化并支持CVD的一级预防。它们对于在临床和太空中辐射暴露后对CVD的个体风险估计也可能有用。在本综述中，我们总结了宇航员辐射风险评估的独特方面，并评估了最广泛使用的CVD CPM在NASA辐射风险评估应用中的用途。我们描述了一个全面的两用风险评估框架，该框架使用定量指标支持太空辐射健康风险的临床护理和运营管理。这种方法是使用个性化医学进行辐射风险评估以支持NASA宇航员安全高效的太空飞行和长期生活质量的第一步。
