Since this was fundamentally an Earth based investigation with impact/benefits for astronauts, virtually all the findings are relevant for cardiovacular medicine on Earth. The focus of our studies was on the clinical question of how to track and interpret imaging data regarding progression of coronary artery disease. For our studies, we concentrated on coronary artery calcium (CAC) scoring, which gives reliable, clinically relevant information about the overall burden of atherosclerosis in the coronary arteries. Many doctors (including NASA flight surgeons) will get repeat scans to follow the progression of disease. However the clinical implications of such changes, particularly in a relatively young population are unknown. They key benefits from our studies are: 1). DEFINED HOW TO QUANTIFY PROGRESSION OF CAC: Our publication: Paixao ARM...Levine BD et al. Disagreement Between Different Definitions of Coronary Artery Calcium (CAC) Progression. JACC: Imaging, 2014, in press, demonstrated that different methods of quantifying the "progression" of CAC can result in divergent classification in up to 30% of individuals. The most common clinical definition of >15% per year, which is used currently by NASA flight surgeons, is too sensitive to the baseline CAC value and frequently gives erroneous information, especially in patients with low baseline levels of CAC (for example an increase of 1 to 2, 10 to 11, or 100 to 101 reflect a 100%, 10%, and 1% change, but would still reflect the same absolute change in CAC). It is likely that this paper, along with the subsequent paper described in #2 will substantially change how physicians interpret repeat CAC scans. 2). DETERMINED THAT THE FINAL CAC SCORE, RATHER THAN A MEASURE OF DISEASE PROGRESSION IS THE MOST IMPORTANT PIECE OF INFORMATION FOR PREDICTING CLINICAL EVENTS. So if serial CAC scanning is performed by any physician (including flight surgeons), the latest scan should be used for risk assessment; knowledge of the change in CAC leading to this subsequent score will provide no independent prognostic information. This new finding obviates the need for complex calculations regarding rate of progression, and emphasizes that risk for future events depends mainly on the overall atherosclerotic burden, not on how fast the disease progresses. Radford NB...Levine BD et al. Baseline Value, Follow-Up Value and Progression Rate of Coronary Artery Calcification Score and Risk of Incident Cardiovascular Disease Events. Submitted JAMA 08/2014. 3). HIGHER DEGREES OF FITNESS MITIGATE THE EFFECT OF CAC AT ANY AGE OR LEVEL OF CAC. This study shows that for patients with large amounts of CAC, being high fit reduces the risk of cardiovascular events. It also determines the amount of fitness that is required to afford the most protection at any given age, or amount of CAC. The information will be very important to health care providers to reduce the risk of CV events by prescribing specific levels of fitness. DeFina LF...Levine BD et al. Cardiorespiratory Fitness, Coronary Artery Calcium and Cardiovascular Disease Events. To be presented at American Heart Association meetings 2014. 4). DEVELOPED THE ASTRO-CHARM (Cardiovascular Health and Risk Modification). This score quantifies global cardiovascular risk in a relatively young population like the astronaut corps, using routine clinical information plus a CAC score. After final validation, this scoring system will be placed on-line and made available for all medical practitioners to get a more accurate assessment of cardiovascular risk in their patients. 5). DEMONSTRATED THAT INCREASED FITNESS PROTECTS AGAINST THE DEVELOPMENT OF DIABETES IN PATIENTS ON STATINS. This study provides a strategy (increasing fitness) to prevent diabetes in patients placed on statins. Radford NB...Levine BD et al Impact of Fitness on Incident Diabetes from Statin Use in Primary Prevention. Submitted Mayo Clinic Proceedings 07/2014.