SAN DIEGO — Systemic arterial endothelial dysfunction was significantly related to higher levels of triglycerides and fasting blood glucose, but not to other cardiovascular risk factors in a long-term follow-up study of patients with Kawasaki disease, Brian W. McCrindle, M.D., reported at an international Kawasaki disease symposium.
Those particular factors “may be indicators of ongoing inflammation, which may be addressed by long-term aspirin use, antioxidant vitamins, or, in extreme cases, use of a statin,” Dr. McCrindle, a pediatric cardiologist at the Hospital for Sick Children, Toronto, told FAMILY PRACTICE NEWS.
The findings suggest systemic arterial endothelial dysfunction is not present in the long term after Kawasaki disease and that brachial artery activity is not related to the degree of past or current coronary artery involvement.
Dr. McCrindle said that he was surprised by the findings, which conflict with similar reports from Japanese investigators.
“The difference may be in the control population used for comparison, with North American children being more sedentary, having poorer nutrition, and being more overweight [compared with Japanese children], meaning that even normal is abnormal.”
Dr. McCrindle and his associates enrolled 52 patients, aged 10-20 years, who had their initial episode of Kawasaki disease between 1982 and 1998 and who had been followed for a mean of 11 years. A group of 60 normal controls matched for age and gender.
The investigators performed a cardiovascular risk assessment of all participants, including questions about smoking and smoke exposure, family history of cardiovascular disease, and attitudes and practices regarding physical activity. Patients completed a food frequency questionnaire and were asked to recall food they'd consumed in the last 3 days; they also underwent detailed height and weight measurements, fasting blood work, a fasting lipid profile, and urinalysis. Systemic arterial endothelial function was obtained assessing brachial artery reactivity (BAR).
The mean BAR dilatation in Kawasaki disease patients was 8.9%, which was not significantly different from the controls (9.4%), and was not related to any disease characteristic or measure of current or past coronary artery lesions.
In addition, the investigators observed no differences between the BAR of Kawasaki disease patients and that of controls in terms of age, gender, Tanner stage, skinfold thickness percentile, body mass index z score, physical activity levels of the patient or family members, or responses to the dietary assessment.
The lab results showed no differences between the two groups in terms of total cholesterol; HDL; LDL; apolipoproteins A1, B, or E; lipoprotein (a); homocysteine or fibrinogen levels; or 24-hour microalbumin excretion.
However, decreased BAR in Kawasaki disease patients was significantly and independently related to higher triglyceride levels and higher fasting blood glucose levels.
“Based on these results, we conclude that systemic arterial endothelial dysfunction does not appear to be present after Kawasaki disease.”