Background: It is uncertain whether Kawasaki disease (KD) increases overall long term cardiovascular risk, especially in those without demonstrable coronary artery lesions. Data from non-invasive vascular assessment, extrapolated from studies of subclinical atherosclerosis, are conflicting.
Methods: Patients at least 2 years post-KD and healthy controls had fasting plasma glucose, lipid profile, high sensitivity C-reactive protein, carotid-femoral pulse wave velocity (PWV), carotid intima-media thickness (cIMT), abdominal aorta intima-media thickness (aIMT), retinal vascular calibre, carotid and aortic elastography performed.
Results: 37 controls and 45 patients with KD (21 with regressed or persistent coronary artery changes) were studied at mean ± sd of 10.5 ± 5.7 years following KD. Compared to controls, KD patients did not have increased traditional cardiovascular risk factors; blood pressure, body mass index, waist-to-hip ratio, glucose, cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglyceride and smoking history.
Of the cohort, 26 patients (age 15.38 ± 6.19 years) and 27 controls (age 18.7 ± 7.11 years) have had cIMT, aIMT and carotid elastography analysed. The maximum aIMT in KD patients was 0.65 ± 0.15 mm, compared to 0.63 ± 0.13 mm in controls, with the most marked difference in those with coronary artery changes at 0.68 ± 0.14 mm. After adjusting for age, sex, systolic blood pressure, aortic diastolic diameter and high sensitivity C- reactive protein, the average maximum aIMT in all KD patients was 0.071mm larger (95% CI -0.005, 0.147) than controls. Aortic elastography and Doppler pulse wave analysis are underway. Otherwise, there are no detectible differences in PWV, cIMT, carotid elastography, or retinal vascular calibre between KD patients and controls.
Conclusion: Compared to carotid artery characteristics, changes in the abdominal aorta may be more discriminative markers of long-term cardiovascular risk in KD. Focus on large arteries in longitudinal KD vascular studies are warranted. Recruitment and analysis are ongoing and further results will be presented.