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Meta-analysis: Lipids, vascular function, cardio-cerebrovascular events after previous Kawasaki disease in children
Xiaomei Ma1, Zhimiao Wei2, Wenquan Niu3
1Capital Center for Children's Health, Capital Medical University, Beijing, China (Dr Ma, Wei, and Li); Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China (Drs Ma and Li).
Insights
Childhood Kawasaki disease (KD) is linked to long-term vascular issues and dyslipidemia, increasing cardio-cerebrovascular risks. These risks persist even over a decade post-illness, highlighting the need for ongoing monitoring.
Area of Science:
- Cardiovascular Medicine
- Pediatric Cardiology
- Vascular Biology
Background:
- Kawasaki disease (KD) can lead to chronic vascular inflammation.
- Long-term cardio-cerebrovascular outcomes after childhood KD are not well-established.
Purpose of the Study:
- To investigate the association between childhood KD and subsequent risks of cardio-cerebrovascular diseases.
- To assess long-term vascular health and lipid profiles in KD survivors.
Main Methods:
- A comprehensive meta-analysis of observational studies from major databases (PubMed, Embase, Web of Science).
- Inclusion criteria focused on comparing individuals with and without a history of KD.
- Outcomes assessed included lipid profiles, vascular ultrasound indices (FMD, CIMT, BaPWV), and cardio-cerebrovascular events.
Main Results:
- Meta-analysis of 51 articles revealed significant long-term vascular impairments in KD survivors.
- Reduced high-density lipoprotein cholesterol (HDLC), impaired flow-mediated dilation (FMD), increased carotid intima-media thickness (CIMT), and elevated ankle-brachial pulse wave velocity (BaPWV) were observed.
- A 4.4-fold increased risk of cardio-cerebrovascular events was noted in individuals with a history of KD, persisting over 10 years post-illness.
Conclusions:
- Childhood KD confers lasting impairments in vascular homeostasis and dyslipidemia, irrespective of coronary artery lesion (CAL) status.
- These persistent vascular changes suggest an increased lifetime risk for developing cardio-cerebrovascular diseases.
- The findings underscore the importance of long-term cardiovascular monitoring for Kawasaki disease survivors.
Background:
Chronic vascular inflammation may persist after Kawasaki disease (KD), but the long-term cardio-cerebrovascular prognosis remains unclear. This study aimed to investigate the association between childhood KD and subsequent cardio-cerebrovascular risks.
Methods:
A meta-analysis was performed on observational studies from PubMed, Embase, and Web of Science that compared individuals with and without a history of KD, assessing outcomes including lipid profiles, vascular ultrasound indices, and cardio-cerebrovascular events using a random-effects model.
Results:
Fifty-one articles were meta-analyzed (46 on lipid and vascular markers, 5 on cardio-cerebrovascular events). Pooled analysis revealed reduced high-density lipoprotein cholesterol (HDLC) (weighted mean difference [WMD], 95% CI: -2.54, -4.31 to -0.77), impaired flow-mediated dilation (FMD) (WMD, 95% CI: -3.98, -5.78 to -2.17), increased carotid intima-media thickness (CIMT) (WMD, 95% CI: 0.03, 0.01-0.04), elevated ankle-brachial pulse wave velocity (BaPWV) (WMD, 95% CI: 46.00, 9.21-82.79), and a 4.4-fold increased risk (relative risk, 95% CI: 4.41, 4.02- 4.85) of cardio-cerebrovascular events vs controls. Subgroup analysis demonstrated reduced HDLC levels in patients with coronary artery lesions (CAL) (WMD, 95% CI: -3.70, -6.90 to -0.50) and Asian populations (WMD, 95% CI: -4.17, -6.86 to -1.47), along with FMD (with CAL: WMD, 95% CI: -7.01, -8.99 to -5.04; Asia: WMD, 95% CI: -5.60, -7.18 to -4.01) and increased CIMT (with CAL: WMD, 95% CI: 0.01, 0.00-0.02; Asia: WMD, 95% CI: 0.02, 0.01-0.03). Notably, reductions in both HDLC (WMD, 95% CI: -1.90, -2.39 to -1.40) and FMD (WMD, 95% CI: -5.29, -8.15 to -2.44) persisted in individuals over 10 years after KD.
Conclusion:
This meta-analysis highlights that prior KD, regardless of CAL status, may confer lasting impairments in vascular homeostasis and dyslipidemia, potentially increasing the lifetime risk of developing cardio-cerebrovascular diseases.
