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Coronary Risk Factor Scoring as a Guide for Counseling

A risk factor scoring system for early detection, possible prediction, and counseling to coronary heart disease patients is discussed. Scoring data include dynamic EKG, cholesterol levels, triglycerine content, total lipid level, total phospolipid levels, and electrophoretic patterns. Results indicate such a system is effective in identifying high risk subjects, but that the ability to predict exceeds the ability to prevent heart disease or its complications.

Robert L. Fleck

Analyzing Potential Failures and Effects in a Pilot-Scale Biomass Preprocessing Facility for Improved Reliability

This study demonstrates a failure identification methodology applied to a preprocessing facility generating conversion-ready feedstocks from biomass meeting conversion process critical quality attribute (CQA) specifications. Failure Modes and Effects Analysis (FMEA) was used as an industrially relevant risk analysis approach to evaluate a logging residue preprocessing system to prepare feedstock for pyrolysis conversion. Risk evaluations considered both system-level and operation unit-level assessments considering process efficiency, product quality, cost, sustainability, and safety. Key outputs included estimations of semi-quantitative risk scores for each failure, identification of the failure impacts, identification of failure causes associated with material attributes and process parameters, ranking success rates of failure detection methods, and speculation of potential mitigation strategies for decreasing failure risk scores. Results showed that deviations from moisture specifications had cascading consequences for other CQAs along with process safety implications. Failures linked to fixed carbon specifications carried the highest risk scores for product quality and process efficiency impacts. As increased throughput can be inversely related to meeting product quality specifications; achieving throughput and other material-based CQAs simultaneously will likely require system optimization or prioritization based on system economics. Ultimately, this work successfully demonstrates FMEA as a risk analysis approach for other bioenergy process systems.

09 BIOMASS FUELS

NASA Screening and Clinical Practice for the Monitoring and Mitigation of Coronary Artery Disease: Application to Terrestrial Practice

Coronary artery disease (CAD) surveillance has led to the development of risk stratification tools that drive clinical mitigation efforts for CAD risk. As common risk assessment tools, including the Framingham Risk Score (FRS) or Pooled Cohort Risk Equations, have insufficient accuracy on an individual level to meet NASA’s stringent screening guidelines, NASA has required new approaches to address the risk of catastrophic cardiovascular (CV) medical events among astronauts. Coronary artery calcium (CAC) scanning has emerged as the current best tool to enhance CV risk assessment in asymptomatic individuals, with risk information incremental to FRS data.

Khera, Amit

Sensor Analysis, Modeling, and Test for Robust Propulsion System Autonomy

An approach is presented supporting analysis, modeling, and test validation of operational flight instrumentation (OFI) that facilitates critical functions for the Space Launch System (SLS) main propulsion system (MPS). Certain types of OFI sensors were shown to exhibit highly nonlinear and non-gaussian noise characteristics during acceptance testing, motivating the development of advanced modeling and simulation (M&S) capability to support algorithm verification and flight certification. Hardware model and algorithm simulation fidelity was informed by a risk scoring metric; redesign of high-risk algorithms using test-validated sensor models significantly improved their expected performance as evaluated using Monte Carlo acceptance sampling methods. Autonomous functions include closed-loop ullage pressure regulation, pressurant leak detection, and fault isolation for automated safing and crew caution and warning (C&W).

Orr, Jeb S.

Development of the Suited Injury Modes and Effects Analysis for Identification of Top Injury Risks in Lunar Missions and Training

A new Exploration Extravehicular Activity Services (xEVAS) suit is being designed to replace the current Extravehicular Mobility Unit (EMU) for the National Aeronautics and Space Administration’s (NASA’s) Artemis program to return astronauts to the lunar surface. This new suit will allow for increased range of motion compared to the current EMU and Apollo era suits and additional features will enhance the health and safety of exploration. With the design of lunar missions and the xEVAS suit progressing, it is important to consider possible injuries and injury mechanisms that could occur in the suit. To address these concerns, the suited Injury Modes and Effects Analysis (IMEA) was developed to outline suited injury scenarios and rank them based on risk score. The IMEA documents possible scenarios and underlying mechanisms of injury. History has shown that more suit injuries occur during training than in flight; therefore, currently planned training events to prepare for lunar missions and tasks during lunar surface EVAs were considered. Each scenario is ranked with likelihood and consequence scorings based on our current understanding of suit and application of Artemis design reference missions. The scoring allowed identification of the high-risk cases that will drive further work in suited injury. Mechanisms of injury, injury outcomes, and mitigation strategies are evaluated within each scenario. The Suited Injury Summit was held on January 5, 2022, to vet the IMEA with external experts. This was an all-day virtual meeting with the suited injury team; ergonomists; suit engineers; safety engineers; the flight operations directorate; flight doctors; astronauts; astronaut strength, conditioning, and rehabilitation specialists (ASCRS); and external subject matter experts (SMEs). External SMEs consisted of surgeons with varying specialties. The intent of this meeting was to walk through the top injury risks identified in the analysis, identify any gaps that were not captured, and discuss mitigations. With participation from all groups, countless lessons-learned came from the Summit meeting. Using these, the top 10 risks have been identified: neutral buoyancy laboratory training, hand/glove injuries, poor suit fit, field training, specific EVA tasks/design of task, boots/ankle injuries, falls from heights, background radiation, repetitive contact, and ambulation/longdistance ambulation. Mitigation steps have also been determined for each of the top risks. The IMEA and documentation of top risks is a living document. Yearly meetings are planned to update the analysis and reevaluate top risks and mitigations. The IMEA is being used to drive work in suited injury, and this work will continue to evolve with IMEA and lunar mission updates.

Teresa Reiber

The POINTER Imaging baseline cohort: Associations between multimodal neuroimaging biomarkers, cardiovascular health, and cognition

Abstract INTRODUCTION The U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (U.S. POINTER) is evaluating lifestyle interventions in older adults at risk for cognitive decline and dementia. Here we characterize the baseline data set of the POINTER Imaging ancillary study. METHODS Participants underwent health and cognitive assessments and neuroimaging with multimodal positron emission tomography (PET) (beta‐amyloid [Aβ] and tau) and magnetic resonance imaging (MRI). Framingham risk score (FRS) was used to quantify cardiovascular disease (CVD) risk. RESULTS A total of 1052 participants (31% from underrepresented ethnoracial groups) were enrolled. Compared to Aβ−, Aβ+ (29%) participants were older, had higher apolipoprotein E (APOE) ε4 carriage rate and white matter hyperintensity volume, and greater temporal tau. FRS was related to MRI measures, but not AD biomarkers. FRS and tau had independent effects on cognition. DISCUSSION In this heterogenous, at‐risk cohort, CVD risk was related to more abnormal brain structure and poorer cognition, representing a putative non‐AD (Alzheimer's disease) pathway to brain injury and cognitive decline. Highlights The U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (U.S. POINTER) cohort is enriched for cardiovascular disease (CVD) and poor lifestyle POINTER Imaging collected multimodal neuroimaging data in this unique, at‐risk cohort Amyloid burden was related to age, apolipoprotein E (APOE) ε4 carriage, and measures of disease progression Associations between amyloid and tau, and tau and cognition, were relatively weak CVD risk and tau pathology were independently related to memory

Neurosciences & Neurology

Aviation security screening optimizer for risk and throughput (ASSORT)

The increasing number of air travelers each year presents a challenge as many airports are near their capacity in terms of resources and space for passenger screening. Fortunately, advancements in technologies like next-generation millimeter wave scanning offer solutions to ease this strain. The focus remains on managing risk while enhancing the passenger experience for the traveling public. The risk model presented in this paper known as the Aviation Security Screening Optimizer for Risk and Throughput (ASSORT) is designed to assess risk-based approaches for passenger screening and checkpoint operations. Additionally, ASSORT is exploring various traveler categories — general, trusted, and trusted-plus — along with different checkpoint screening Concept of Operations tailored to each traveler type. For instance, travelers with a higher trust level may experience fewer screening technologies, resulting in quicker processing times at the checkpoint. The output of ASSORT provides a risk score for predefined threat scenarios, as well as the overall risk to the checkpoint, aircraft, and airport by traveler type. In conclusion, benefits of using this tool include assessing the trade-offs between the overall risk associated with checkpoints and the throughput rate of passengers screened. We show for example the impact that different passenger volumes at the checkpoint can have on risk.

99 GENERAL AND MISCELLANEOUS

Genetic variations and their interaction with thirdhand smoke exposure on anxiety and memory in Collaborative Cross mice

Thirdhand smoke (THS) is linked to adverse health effects, but the effect of genetic variations on behavioral outcomes is poorly understood. To investigate this, we assessed anxiety- and memory-related behaviors in 820 mice from 21 strains of the genetically diverse Collaborative Cross (CC) mouse that were exposed to THS from 4 through 10 weeks of age. Anxiety was evaluated with a light/dark box assay with a previously established risk score system. Females were generally more sensitive: THS reduced anxiety risk in strains CC013, CC019, and CC051, but increased risk in CC036 and CC061, while males showed no significant effects. Memory was tested using passive avoidance: impairments were observed in both sexes in CC016 and CC019, with sex-dependent effects in CC002 and CC051. A genome-wide association study identified 2,347 SNPs associated with anxiety and 1,568 SNPs with memory, with 32 and 85 SNPs, respectively, interacting with THS exposure. Enrichment analyses revealed distinct biological processes underlying susceptibility, including axonogenesis, synapse organization, cognition, and learning and memory. KEGG pathway analysis identified distinct genetic pathways, including GTPase binding and GTPase regulatory activity, that act as critical molecular switches in the brain that regulate synaptic plasticity, dendritic spine structure, and neuronal signaling, directly influencing anxiety-like behaviors and memory formation. These findings show that THS exposure affects neurobehavioral outcomes in a sex- and genotype-dependent manner, highlighting critical gene-environment interactions and providing a foundation for mechanistic insights into THS neurotoxicity

Anxiety

Proactive Wildfire Management: A Remote Sensing and Multimodal CNN-MLP Architecture for Ignition Risk Forecasting

As the frequency and intensity of wildfires increase, with fire seasons now starting earlier and ending later than they have over the past decades, current monitoring systems, such as lookout towers and satellites, are hindered by cloud cover, low-resolution imagery, and static data gaps that fail to track vegetation moisture levels fast enough to catch rapid pre-ignition changes. This report proposes a Machine Learning-enabled Wildfire Ignition Prediction framework that combines satellite monitoring with dynamic and high-resolution remote sensing from Unmanned Aerial Vehicle (UAV) swarms. The method would use multispectral and thermal data from the Landsat program to create a baseline for vegetation health, calculating a two-band Enhanced Vegetation Index (EVI2) and the moisture content of the vegetation. These inputs will later be fused with microscale UAV weather data, including thermal hotspots found through thick canopies, hyperspectral chemical signatures of pre-visual combustion, and local weather streams. The multispectral satellite, multispectral Light Detection and Ranging (LiDAR), and thermal data would then be processed through a Convolutional Neural Network (CNN), alongside a Multilayer Perceptron (MLP) for the micro-weather telemetry. The outputs of these networks would be fused into a single feature representation and passed through a final prediction network to generate real-time ignition risk scores and hotspot alerts. Model performance would be assessed using standard classification metrics, including a Receiver Operating Characteristic - Area Under the Curve (ROC AUC) and F1 score. This system would allow first responders to identify high-risk zones and intervene before ignition occurs, improving emergency response time compared to current approaches.

machine learning

Cyber100 Compass [SWR 23-64]

Cyber100 Compass ("Compass") is a unique risk assessment framework that will enable grid system planners to understand and mitigate cybersecurity risk for grids transitioning to high levels of renewable generation, including 100%. The idea for Compass was developed by NREL based on past work on high-renewable grids and a series of discussions with DOE. Compass is part of Cyber100, a portfolio of proposed research activities that would greatly expand understanding of cybersecurity for high-renewable grids. Compass is a desktop application designed with a user-friendly interface. The tool gathers information from users, conducts probabilistic backend calculations, and outputs a series of visualizations to help users understand and analyze their cybersecurity risks based on the unique features of their future grid. Compass will take as inputs the values for different conditions and produce a risk score of the resulting grid. By trying different configurations, system planners can compare the resultant risks against their own risk tolerance and decide which system-of-system controls to implement as they transition toward a 100% renewable grid.

Martin, Maurice

Development of the Suited Injury Modes and Effects Analysis for Identification of Top Injury Risks in Lunar Missions and Training

A new Exploration Extravehicular Activity Suit (xEVAS) is being designed to replace the current Extravehicular Mobility Unit (EMU) for the National Aeronautics and Space Administration’s (NASA’s) Artemis program to return astronauts to the lunar surface. This new suit will allow for increased range of motion compared the current EMU and Apollo era suits and will have additional features that will enhance the health and safety of exploration. With the design of lunar missions and the xEVAS progressing, it is important to consider possible injuries and injury mechanisms that could occur in the suit. To address these concerns, the suited Injury Modes and Effects Analysis (IMEA) was developed to outline suited injury scenarios and rank them based on risk score. The IMEA documents possible scenarios and underlying mechanisms of injury while wearing an extravehicular activity (EVA) suit. Tasks during lunar surface EVA as well as training events to prepare for lunar missions were considered as history has shown that more suit injuries occur during training than in flight. Each scenario is ranked with a consequence and likelihood scoring based on our current understanding of the suit and Artemis design reference missions to identify high-risk cases that will drive further work in suited injury. Injuries, mechanisms of injury, and mitigation strategies are evaluated within each scenario. The Suited Injury Summit was held on January 5, 2022, to vet the IMEA with external experts. This was an all-day virtual meeting with the suited injury team, ergonomists, suit engineers, safety engineers, the flight operations directorate, flight doctors, astronauts, astronaut strength, conditioning, and rehabilitation specialists (ASCRS), and external subject matter experts (SMEs). External SMEs consisted of surgeons with varying specialties. The intent of this meeting was to walk through the top injury risks identified in the analysis, identify any gaps that were not captured, and discuss mitigations. With participation from all groups, countless lessons-learned came from the Summit meeting. Using the lessons-learned and discussion from the Summit, the top 10 risks have been identified: neutral buoyancy laboratory training, hand/glove injuries, poor suit fit, field training, specific EVA tasks/design of task, boots/ankle injuries, falls from heights, background radiation, repetitive contact, and ambulation/long-distance ambulation. Mitigation steps have also been determined for each of the top risks. The IMEA and documentation of top risks is a living document. Yearly meetings are planned to update the analysis and reevaluate top risks and mitigations. The IMEA is being used to drive work in suited injury, and this work will continue to evolve with IMEA and lunar mission updates.

Teresa Reiber

Development of the Suited Injury Modes and Effects Analysis for Identification of Top Injury Risks in Lunar Missions and Training

A new Exploration Extravehicular Activity Suit (xEVAS) is being designed to replace the current Extravehicular Mobility Unit (EMU) for the National Aeronautics and Space Administration’s (NASA’s) Artemis program to return astronauts to the lunar surface. This new suit will allow for increased range of motion compared the current EMU and Apollo era suits and will have additional features that will enhance the health and safety of exploration. With the design of lunar missions and the xEVAS progressing, it is important to consider possible injuries and injury mechanisms that could occur in the suit. To address these concerns, the suited Injury Modes and Effects Analysis (IMEA) was developed to outline suited injury scenarios and rank them based on risk score. The IMEA documents possible scenarios and underlying mechanisms of injury while wearing an extravehicular activity (EVA) suit. Tasks during lunar surface EVA as well as training events to prepare for lunar missions were considered as history has shown that more suit injuries occur during training than in flight. Each scenario is ranked with a consequence and likelihood scoring based on our current understanding of the suit and Artemis design reference missions to identify high-risk cases that will drive further work in suited injury. Injuries, mechanisms of injury, and mitigation strategies are evaluated within each scenario. The Suited Injury Summit was held on January 5, 2022, to vet the IMEA with external experts. This was an all-day virtual meeting with the suited injury team, ergonomists, suit engineers, safety engineers, the flight operations directorate, flight doctors, astronauts, astronaut strength, conditioning, and rehabilitation specialists (ASCRS), and external subject matter experts (SMEs). External SMEs consisted of surgeons with varying specialties. The intent of this meeting was to walk through the top injury risks identified in the analysis, identify any gaps that were not captured, and discuss mitigations. With participation from all groups, countless lessons-learned came from the Summit meeting. Using the lessons-learned and discussion from the Summit, the top 10 risks have been identified: neutral buoyancy laboratory training, hand/glove injuries, poor suit fit, field training, specific EVA tasks/design of task, boots/ankle injuries, falls from heights, background radiation, repetitive contact, and ambulation/long-distance ambulation. Mitigation steps have also been determined for each of the top risks. The IMEA and documentation of top risks is a living document. Yearly meetings are planned to update the analysis and reevaluate top risks and mitigations. The IMEA is being used to drive work in suited injury, and this work will continue to evolve with IMEA and lunar mission updates.

Tessa Reiber

Menstrual Cycle Control in Female Astronauts and the Associated Risk of Venous Thromboembolism

Venous thromboembolism (VTE) is a common and serious condition affecting approximately 1‐2 per 1000 people in the USA every year. There have been no documented case reports of VTE in female astronauts during spaceflight in the published literature. Some female astronauts use hormonal contraception to control their menstrual cycles and it is currently unknown how this affects their risk of VTE. Current terrestrial risk prediction models do not account for the spaceflight environment and the physiological changes associated with it. We therefore aim to estimate a specific risk score for female astronauts who are taking hormonal contraception for menstrual cycle control, to deduce whether they are at an elevated risk of VTE. A systematic review of the literature was conducted in order to identify and quantify known terrestrial risk factors for VTE. Studies involving analogues for the female astronaut population were also reviewed, for example, military personnel who use the oral contraceptive pill for menstrual suppression. Well known terrestrial risk factors, for example, obesity or smoking would not be applicable to our study population as these candidates would have been excluded during astronaut selection processes. Other risk factors for VTE include hormonal therapy, lower limb paralysis, physical inactivity, hyperhomocysteinemia, low methylfolate levels and minor injuries, all of which potentially apply to crew members LSAH data will be assessed to identify which of these risk factors are applicable to our astronaut population. Using known terrestrial risk data, an overall estimated risk of VTE for female astronauts using menstrual cycle control methods will therefore be calculated. We predict this will be higher than the general population but not significantly higher requiring thromboprophylaxis. This study attempts to delineate what is assumed to be true of our astronaut population, for example, they are known to be a healthy fit cohort of individuals, and combine physiological impacts of spaceflight (cephalic fluid shifts, lower limb inactivity) to understand specific risks associated with hormonal contraception.

Jain, Varsha

Using Machine Learning to Understand Electric and Hybrid Vehicles Ownership in Burdened and Nonburdened Communities

Transitioning to electric and hybrid vehicles (EHVs) for all communities is a pivotal step toward sustainable transportation and environmental conservation. This paper aims to understand the adoption of EHVs, focusing on burdened communities (BCs) in the United States. The EHV ownership-based analysis combines two datasets—behavioral data from the Puget Sound Regional Travel Survey integrated with BCs (Justice40) data covering transportation insecurity, environmental burden, social vulnerability, health vulnerability, and climate and disaster risk burden. After creating this unique database, descriptive analysis and modeling are used to analyze the data and predict EHV ownership in the future. Specifically, we use a new method that combines particle swarm optimization (PSO) with a stacking model named PSO-Stacking, which incorporates heterogeneous base learners of machine learning and deep learning. PSO applies a customized objective function to select the optimal hyperparameters for heterogeneous learners within the stacking model, effectively addressing challenges such as multicollinearity, data imbalance, nonlinearity, and overfitting. The proposed solution covers more accurate results than standard benchmark models for EHV ownership in BCs and non-BCs. In addition, the results of the PSO-Stacking method are explained using the local interpretable model-agnostic explanations technique. Results show a negative correlation between the BCs indicators, that is, higher transportation insecurity associated with lower EHV ownership. Furthermore, BCs have higher future climate risk scores, diesel particulate matter levels, and PM2.5 in the air than non-BCs because of higher conventional vehicle ownership. These communities are at higher risk and can benefit from electrification, EV infrastructure, and EV policies to address environmental challenges.

Aslam, Zeeshan [ORNL]

Defining the Relationship between Biomarkers of Oxidative and Inflammatory Stress and the Risk for Atherosclerosis in Astronauts during and after Long-duration Spaceflight

Future human space travel will consist primarily of long-duration missions onboard the International Space Station (ISS) or exploration-class missions to Mars, its moons, or nearby asteroids. These missions will expose astronauts to increased risk of oxidative and inflammatory damage from a variety of sources, including radiation, psychological stress, reduced physical activity, diminished nutritional status, and hyperoxic exposure during extravehicular activity. Evidence exists that increased oxidative damage and inflammation can accelerate the development of atherosclerosis. PURPOSE The purpose of this investigation is to determine whether biomarkers of oxidative and inflammatory stress are elevated during and after long-duration spaceflight and investigate if a relation exists between levels of these biomarkers and structural and functional indices of atherosclerotic risk measured in the carotid and brachial arteries. This is the first study to propose assessing atherosclerotic risk using biochemical, structural, and functional measures before, during, and immediately after spaceflight, and structural and functional measures for up to 5 years after landing. METHODS We will study 12 astronauts before, during, and up to 5 years after long-duration ISS missions. A panel of biomarkers of oxidative and inflammatory stress will be measured twice before flight, early (flight days 15 and 60) and late (2 weeks before landing) during the mission, and early in the postflight recovery phase (approx 3 days after landing). Arterial structure and vascular compliance will be measured at the same times and also at 1, 3, and 5 years after landing (surveillance). Arterial function will be measured using the same preflight, postflight, and surveillance schedule as arterial structure and vascular compliance measures, but will not be measured inflight. Biomarkers, some of which we have previously shown to be elevated with spaceflight, will be measured in venous blood samples and 24-h (in-flight) and 48-h (pre- and post-flight) urine pools. Arterial structure will be assessed from measures of carotid intima-media thickness, which have been shown to be better indicators of atherosclerotic than the Framingham Risk Score. Arterial function will be assessed using brachial flow-mediated dilation, a well-validated measure used to assess endothelium-dependent vasodilation and is a sensitive predictor of atherosclerotic risk. Arterial pulse pressure measured in the brachial artery and stroke volume measured from cardiac ultrasound will be used to assess hemodynamic status, cardiac function, and systemic vascular compliance. Three astronauts are actively participating in the preflight data collection and training activities. One astronaut has completed all preflight activities and will participate in the first in-flight data collection sessions by the end of 2013. The first post-flight data collection sessions will occur in the spring of 2014. EXPECTED RESULTS We hypothesize that biomarkers of oxidative and inflammatory stress will increased with spaceflight and will correlate with increased carotid intima-media thickness during and after flight and with decreased flow-mediated dilation after the mission. Furthermore, we hypothesize that measures of oxidative stress will return to baseline after flight, but biomarkers of inflammatory stress and vascular indices of atherosclerotic risk will remain elevated.

Lee, Stuart M. C.

Defining the Relationship Between Biomarkers of Oxidative and Inflammatory Stress and the Risk for Atherosclerosis in Astronauts During and After Long-Duration Spaceflight

Future human space travel will primarily consist of long-duration missions aboard the International Space Station (ISS) or exploration class missions to Mars, its moons, or nearby asteroids. These missions will expose astronauts to increased risk of oxidative and inflammatory damage primarily from radiation, but also from psychological stress, reduced physical activity, diminished nutritional status, and, in the case of extravehicular activity, hyperoxic exposure. There is evidence that increased oxidative damage and inflammation can accelerate the development of atherosclerosis. PURPOSE The purpose of this proposal is to identify biomarkers of oxidative and inflammatory stress and to correlate them to indices of atherosclerosis risk before, during, and after long-duration spaceflight. METHODS To meet the objectives of the study, we will study astronauts before, during, and up to 5 years after long-duration missions aboard ISS. Biomarkers of oxidative and inflammatory stress, some of which we have previously shown to be elevated with spaceflight, will be measured before, during, and after spaceflight. Arterial structure will be monitored using ultrasound to measure carotid intima-medial thickness before, during, and after weightlessness. Carotid intima-medial thickness has been shown to be a better indicator than Framingham Risk scores for prediction of atherosclerosis. Arterial function will be monitored using brachial flow-mediated dilation before flight and after landing. Brachial flow-mediated dilation is a good index of endothelium-dependent vasodilation, which is a sensitive predictor of atherosclerotic risk. This is the first study to propose assessing atherosclerotic risk using biochemical, structural, and functional measures before, during, and immediately after spaceflight and structural functional measures for up to 5 years after landing. EXPECTED RESULTS We hypothesize that these biomarkers of oxidative and inflammatory stress will be increased with spaceflight and will correlate with increased carotid intima-medial thickness in- and postflight and with decreased flow-mediated dilation after the mission. Furthermore, we hypothesize that measures of oxidative stress will return to baseline after flight, but that biomarkers of inflammatory stress and vascular indices of atherosclerosis risk will remain elevated.

Lee, Stuart M. C.

Traditional Cardiovascular Risk Factors as Predictors of Cardiovascular Events in the U.S. Astronaut Corps

Risk prediction equations from the Framingham Heart Study are commonly used to predict the absolute risk of myocardial infarction (MI) and coronary heart disease (CHD) related death. Predicting CHD-related events in the U.S. astronaut corps presents a monumental challenge, both because astronauts tend to live healthier lifestyles and because of the unique cardiovascular stressors associated with being trained for and participating in space flight. Traditional risk factors may not hold enough predictive power to provide a useful indicator of CHD risk in this unique population. It is important to be able to identify individuals who are at higher risk for CHD-related events so that appropriate preventive care can be provided. This is of special importance when planning long duration missions since the ability to provide advanced cardiac care and perform medical evacuation is limited. The medical regimen of the astronauts follows a strict set of clinical practice guidelines in an effort to ensure the best care. The purpose of this study was to evaluate the utility of the Framingham risk score (FRS), low-density lipoprotein (LDL) and high-density lipoprotein levels, blood pressure, and resting pulse as predictors of CHD-related death and MI in the astronaut corps, using Cox regression. Of these factors, only two, LDL and pulse at selection, were predictive of CHD events (HR(95% CI)=1.12 (1.00-1.25) and HR(95% CI)=1.70 (1.05-2.75) for every 5-unit increase in LDL and pulse, respectively). Since traditional CHD risk factors may lack the specificity to predict such outcomes in astronauts, the development of a new predictive model, using additional measures such as electron-beam computed tomography and carotid intima-media thickness ultrasound, is planned for the future.

Halm, M. K.