title: The Bellagio Report: Cardiovascular risks of spaceflight: implications for the future of space travel.
abstract: BACKGROUND
  Long-duration space missions, as well as emerging civilian tourist space travel activities, prompted review and assessment of data available to date focusing on cardiovascular risk and available risk mitigation strategies. The goal was the creation of tools for risk priority assessments taking into account the probability of the occurrence of an adverse cardiovascular event and available and published literature from spaceflight data as well as available risk mitigation strategies.
  
  
  METHODS
  An international group of scientists convened in Bellagio, Italy, in 2004 under the auspices of the Aerospace Medical Association to review available literature for cardiac risks identified in the Bioastronautics Critical Path Roadmap (versions 2000, 2004). This effort led to the creation of a priority assessment framework to allow for an objective assessment of the hazard, probability of its occurrence, mission impact, and available risk mitigation measures.
  
  
  CONCLUSIONS
  Spaceflight data are presented regarding evidence/ no evidence of cardiac dysrhythmias, cardiovascular disease, and cardiac function as well as orthostatic intolerance, exercise capacity, and peripheral resistance in presyncopal astronauts compared to non-presyncopal astronauts. Assessment of the priority of different countermeasures was achieved with a tabular framework with focus on probability of occurrence, mission impact, compliance, practicality, and effectiveness of countermeasures. Special operational settings and circumstances related to sensitive portions of any mission and the impact of environmental influences on mission effectiveness are addressed. The need for development of diagnostic tools, techniques, and countermeasure devices, food preparation, preservation technologies and medication, as well as an infrastructure to support these operations are stressed. Selected countermeasure options, including artificial gravity and pharmacological countermeasures need to be systematically evaluated and validated in flight, especially after long-duration exposures. Data need to be collected regarding the emerging field of suborbital and orbital civilian space travel, to allow for sound risk assessment.
authors.affiliation: Aerospace Medical Association, Alexandria, VA, USA.
authors.forename: Marian B
authors.initials: MB
authors.lastname: Sides
authors.forename: Joan
authors.initials: J
authors.lastname: Vernikos
authors.forename: Victor A
authors.initials: VA
authors.lastname: Convertino
authors.forename: Jan
authors.initials: J
authors.lastname: Stepanek
authors.forename: Lloyd D
authors.initials: LD
authors.lastname: Tripp
authors.forename: Jorg
authors.initials: J
authors.lastname: Draeger
authors.forename: Alan R
authors.initials: AR
authors.lastname: Hargens
authors.forename: Chrysoula
authors.initials: C
authors.lastname: Kourtidou-Papadeli
authors.forename: Anne
authors.initials: A
authors.lastname: Pavy-LeTraon
authors.forename: Thais
authors.initials: T
authors.lastname: Russomano
authors.forename: Julielynn Y
authors.initials: JY
authors.lastname: Wong
authors.forename: Regina R
authors.initials: RR
authors.lastname: Buccello
authors.forename: Peter H
authors.initials: PH
authors.lastname: Lee
authors.forename: Vishal
authors.initials: V
authors.lastname: Nangalia
authors.forename: M Joan
authors.initials: MJ
authors.lastname: Saary
mesh_terms: D001145:Arrhythmias, Cardiac / Q000209:etiology; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control; D017408:Guidelines as Topic; D006801:Humans; D018472:Hypogravity / Q000009:adverse effects; D007391:International Cooperation; D012189:Retrospective Studies; D018570:Risk Assessment; D013026:Space Flight