Kawasaki disease and subsequent risk for atherosclerosis

Abstract

A major complication of Kawasaki disease is inflammation and vasculitis of the coronary arteries. This may lead to coronary artery aneurysms. An important question is whether those without aneurysms have increased long-term risk of atherosclerosis. In this issue of The Journal two studies address this question. McCrindle et al found that patients, after Kawasaki disease, have some abnormalities in cardiovascular risk factors, but have no evidence for systemic arterial endothelial dysfunction. This is reassuring. However, in a separate study, Dalla Pozza et al found that carotid artery intimal-medial thickness was greater in patients after Kawasaki disease than controls and that those with coronary artery involvement after Kawasaki disease had the largest intimal-medial thickness. These findings suggest potentially accelerated atherosclerosis in patients with Kawasaki disease. In an editorial, Selamet Tierney and Newburger point out that we currently must rely on relatively small studies, with differing patient characteristics, different length of followup and intermediate outcomes in which interpretation of the clinical relevance of results may be difficult. They emphasize that long-term international studies with clinical outcomes will be optimum to assess the impact of Kawasaki disease on vascular health. In the meantime, appropriate management of known risk factors, such as hypertension and dyslipidemia, is important to maximize vascular health in patients who have had Kawasaki disease.