Carotid intima-media thickness in children with Kawasaki disease
Raghvendra Singh Meena1, Manojkumar Rohit, Anju Gupta
1Departments of Cardiology, Advanced Cardiac Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Children with Kawasaki disease (KD) show increased carotid intima-media thickness (cIMT), a marker for atherosclerosis. This suggests a higher future cardiovascular risk, even without coronary aneurysms.
Area of Science:
- Pediatric Rheumatology
- Cardiovascular Research
- Vascular Biology
Background:
- Kawasaki disease (KD) is an acute vasculitis in children, with coronary artery abnormalities being a major concern.
- Intravenous immunoglobulin treatment reduces coronary aneurysm incidence, but elevated cardiovascular disease risk persists in some patients.
- Endothelial dysfunction, abnormal lipid profiles, and vessel wall reactivity are implicated in KD's long-term cardiovascular risks.
Purpose of the Study:
- To assess carotid intima-media thickness (cIMT) as a surrogate marker for atherosclerosis in children with a history of KD.
- To evaluate lipid profiles in children diagnosed with KD.
Main Methods:
- A cohort of 27 children diagnosed with KD at least one year prior were enrolled.
- Carotid intima-media thickness (cIMT) was measured at enrollment and after 3 months.
- Fasting lipid profiles were analyzed for all participants.
Main Results:
- Mean cIMT was significantly elevated in children with KD compared to controls.
- Abnormal lipid profiles, including undesirable HDL-C, triglycerides, LDL-C, and total cholesterol, were observed in several patients.
- Higher cIMTs and some proatherogenic lipid abnormalities suggest an increased future risk of atherosclerosis.
Conclusions:
- Children with KD exhibit higher cIMT, indicating a potential for accelerated atherosclerosis.
- The presence of lipid abnormalities further supports an increased cardiovascular risk profile in these patients.
- Further research with larger sample sizes and longer follow-up periods is warranted to confirm these findings.
Abstract:
Kawasaki disease (KD) is an acute medium vessel vasculitis seen in children. The most significant long-term complication is related to coronary artery abnormalities. Use of intravenous immunoglobulins, however, has led to significant reduction in incidence of coronary aneurysms. What is more alarming is the fact that higher risk of cardiovascular disease is seen in even those children who do not have coronary artery aneurysms during subacute phase. Various factors like abnormal lipid profiles, abnormal vessel wall reactivity and endothelial dysfunction have been implicated for this. Carotid intima-media thickness (cIMT) has been used as a surrogate marker for atherosclerosis. This study was planned to evaluate cIMT in children with KD. Twenty-seven children with diagnosis of KD at least 1 year prior to enrolment were evaluated for cIMT at enrolment and then after 3 months. Fasting lipid profile was done for all patients. Mean cIMT was significantly higher in children with KD compared to controls. In lipid profiles, undesirable HDL-C and triglyceride levels were seen in 2 and 3 children, respectively. Undesirable and borderline LDL-C levels were seen in 1 and 2 patients, respectively. Undesirable and borderline total cholesterol levels were seen in 1 and 3 patients, respectively. Higher cIMTs were seen in our cohort of KD patients. Proatherogenic abnormalities in lipid profile were seen in a few patients. Both abnormalities may predict a higher risk of atherosclerosis in future. The results of this study need to be replicated on a larger study sample and over longer follow-up periods.
