Cardiovascular Risk Factors and Ambulatory Blood Pressure Monitoring after Kawasaki Disease

Abstract

Controversy persists as to whether patients who have had Kawasaki disease (KD) are at increased risk for premature atherosclerosis. Previous reports have suggested an increased tendency towards the metabolic syndrome and abnormal endothelial function. Purpose: We sought to determine cardiovascular risk factors in patients after KD. Methods: Complete cardiovascular risk assessment was performed in 43 patients (mean age 15.4±2.3 years; 60% males) at a mean of 9.5±3.2 years after typical KD, including 11% with persistent and 33% with regressed aneurysms, and 56% with ectasia or no coronary artery involvement. Results were related to a concurrent normal control group of 30 adolescents (mean age 15.9±2.5 years; 53% males). Results: There were no significant differences between cases vs. controls regarding body mass index, percent ideal weight for height or percentile of triceps skin fold thickness. There were no significant differences regarding amount of time spent in active and sedentary pursuits, family history of risk factors or cardiovascular disease, or smoking or smoke exposure. There were no significant differences regarding serum electrolytes, creatinine, fasting lipid profile, plasma free fatty acids, insulin and C-peptide levels, apolipoproteins, Lp(a), or urinary microalbumen clearance. From 24-hour ambulatory blood pressure monitoring, cases did not differ significantly from controls regarding mean total, daytime or nighttime systolic or diastolic blood pressure values, except cases had a tendency towards lower mean daytime systolic pressure (113±10 mmHg vs. 118±9 mmHg; p=0.06). However, cases had significantly lesser night-time fall (dipping) in both mean systolic (mean -5.1% vs. -8.4%; p=0.01) and diastolic (-9.6% vs. -12.8%; p=0.05) pressure. This difference dinimished (cases vs. control p=0.086 for systolic and p=0.13 for diastolic dipping) after adjustment for age, gender, BMI and mean daytime pressure measurements. Conclusion: Abnormalities of blood pressure regulation may represent an increased predisposition to hypertension in patients after KD