Strategies for predicting catastrophic cardiovascular events remain largely focused on statistical models that combine traditional atherosclerosis risk factors such as smoking, diabetes, blood pressure and lipids. However, the majority of cardiovascular events occur among individuals classified into low or intermediate risk categories using these models. It is imperative to improve upon these models to optimize cardiovascular risk prediction for the astronaut core, to ensure selection of astronaut candidates who will be able to complete training and exploration missions with extremely low risk of interval cardiovascular events.
Numerous studies have evaluated novel risk markers in an attempt to improve cardiovascular risk prediction, with several promising imaging and blood-based biomarkers identified. Most of these studies have investigated the incremental predictive value of a single biomarker added to a traditional risk factor model, with a few reporting combinations of biomarkers. Moreover, few studies have evaluated strategies for risk prediction that cross testing modalities. Such a multi-modality approach has the potential to markedly improve cardiovascular risk prediction among potential and existing astronauts, and would have direct relevance to the general population.
Dr. de Lemos and colleagues will enhance cardiovascular risk prediction by developing novel strategies that combine risk prediction tests that cross testing modalities. These modalities will include traditional risk factor and fitness assessments, as well as cardiovascular imaging studies, novel protein biomarkers, and genetics. Models will be developed that optimize global cardiovascular disease risk prediction over two time windows:
(1) 10-20 years, representing the full career of the astronaut; and
(2) 2-5 years, representing the planning and operational phase of a manned mission to Mars.