Heart in space: effect of the extraterrestrial environment on the cardiovascular system

Key Points

  • Spaceflight removes the normal loading effects of gravity on the cardiovascular system and initiates 'ageing-like' deconditioning, including loss of physical fitness, arterial stiffening, and development of insulin resistance

  • Exposure to cosmic radiation during space travel might induce late cardiovascular disease

  • Whether a threshold radiation dose exists for adverse cardiovascular effects is still uncertain

  • Countermeasures to reduce the risk of spaceflight-associated, radiation-induced cardiovascular disease include maintenance of physical fitness, dietary and nutraceutical interventions, and radiation shielding


National space agencies and private corporations aim at an extended presence of humans in space in the medium to long term. Together with currently suboptimal technology, microgravity and cosmic rays raise health concerns about deep-space exploration missions. Both of these physical factors affect the cardiovascular system, whose gravity-dependence is pronounced. Heart and vascular function are, therefore, susceptible to substantial changes in weightlessness. The altered cardiovascular function in space causes physiological problems in the postflight period. A compromised cardiovascular system can be excessively vulnerable to space radiation, synergistically resulting in increased damage. The space radiation dose is significantly lower than in patients undergoing radiotherapy, in whom cardiac damage is well-documented following cancer therapy in the thoracic region. Nevertheless, epidemiological findings suggest an increased risk of late cardiovascular disease even with low doses of radiation. Moreover, the peculiar biological effectiveness of heavy ions in cosmic rays might increase this risk substantially. However, whether radiation-induced cardiovascular effects have a threshold at low doses is still unclear. The main countermeasures to mitigate the effect of the space environment on cardiac function are physical exercise, antioxidants, nutraceuticals, and radiation shielding.

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Figure 1: Carotid artery before and after spaceflight.
Figure 2: Flow-mediated dilatation in the brachial artery.
Figure 3: Excess relative risk of cardiovascular disease after radiation exposure.
Figure 4: Pathophysiological mechanisms potentially involved in radiation-induced cardiovascular disease.


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Work in the R.L.H. laboratory is supported by the Canadian Space Agency Contracts 9F007-020213/001/ST, 9F007-046025/001/ST, 9F007-052819/001/ST, 9F053-111259, and 9F053-120610. Work on space radiation protection by M.D. has been supported by the European Space Agency (ESA) under grants IBER and ROSSINI. Work on radiation-induced cardiovascular disease has been supported by the Euratom 7th FP under grant agreement no. 295823 (PROCARDIO). The authors thank Emanuele Scifoni (TIFPA-INFN, Trento, Italy) for his assistance with Figures.

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All the authors researched data for the article, contributed to discussions of content, wrote the manuscript, and reviewed/edited it before submission.

Correspondence to Marco Durante.

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Grays are units of absorbed radiation dose; 1 Gy = 1 J/kg.


Sieverts are derived units of ionizing radiation dose and are a measure of the health effect of low levels of ionizing radiation on the human body.

HZE particles

High-energy and high-charge particles; they are conventionally identified as the ions heavier than helium that can cross a shield of 5 g/cm2 of aluminium.

Van Allen belts

Giant swathes of magnetically trapped, highly energetic charged particles originating from solar wind and galactic cosmic rays that surround the Earth at an altitude of 500–58,000 km.

Solar particle events

Strong emissions of charged particles from the Sun that are associated with solar flares or coronal mass ejections.

High-energy protons

Protons in galactic cosmic rays peak around 1 GeV, whereas those trapped in the Van Allen belts have energy in the range 10–500 MeV.

Fission-spectrum neutrons

Neutrons produced in nuclear reactors; typically the energy peaks around 1 MeV and has a tail reaching 5–6 MeV.

Fast neutrons

High-energy neutrons that are produced by the interaction of high-energy protons with shielding materials.

Linear energy transfer

Charged particle energy loss per unit track length; in radioprotection, linear energy transfer is generally expressed in keV/μm in water.

Relative biological effectiveness

The ratio of the reference radiation dose and the test radiation dose producing the same effect

Dietary Approaches to Stop Hypertension diet

An eating plan that encourages reduction in sodium intake with increases in foods rich in potassium, calcium, and magnesium.

Nuclear fragmentation

The fragmentation of the projectile and/or target nuclei as a result of nuclear interactions between energetic heavy ions and target atoms.

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Hughson, R., Helm, A. & Durante, M. Heart in space: effect of the extraterrestrial environment on the cardiovascular system. Nat Rev Cardiol 15, 167–180 (2018). https://doi.org/10.1038/nrcardio.2017.157

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