Association between PM_2.5 and coronary artery dilatation with Kawasaki disease in China

Kawasaki disease is an acute febrile systemic vasculitis that predominantly affects children and can lead to coronary artery dilatation (CAD), coronary artery aneurysm, and/or thrombosis. This study aimed to investigate whether exposure to particulate matter with a diameter of 2.5 µm (PM_2.5) is associated with an increased risk of CAD. A case-crossover study was conducted to investigate the relationship between PM_2.5 exposure and coronary Z value in children. The study included 847 participants from 2017 to 2021. The Z value was calculated for each participant, and PM_2.5 exposure levels were assigned. The risk effect of PM_2.5 on the Z value was assessed using the distributed lag Poisson generalized linear model. Correlation and mediation analyses were performed to explore the mechanisms underlying CAD, and sensitivity analysis was conducted to verify the stability of the model. PM_2.5 exposure was found to increase the risk of CAD at lag 2-4 days. On the 3rd day of lag, PM_2.5 exposure led to the highest risk of CAD, with RR = 1.11, (95%CI = 1.02, 1.21). Mediation analysis showed that PM_2.5 may induce CAD through C-reactive protein (CRP), alanine aminotransferase (ALT) and hemoglobin (HB), and the effect size was significant, indicating that CRP, ALT and HB were the main mediating factors between PM_2.5 and CAD.

Our results suggest that PM_2.5 exposure is a potential risk factor for CAD in children. CRP, alanine aminotransferase, and hemoglobin were identified as the main mediators regulating the relationship between PM_2.5 and CAD.

• PM2.5 may lead to an increased incidence of Kawasaki disease in children.

• We found that inhalation of PM2.5 may cause coronary artery dilatation in Kawasaki disease through a population-based cohort study. • This process may be mediated by increasing C-reactive protein. • The model results remained stable after sensitivity analysis.