CLINICAL RESEARCH: CONGENITAL HEART DISEASE
Novel and traditional cardiovascular risk factors in children after Kawasaki disease
Implications for premature atherosclerosis
Yiu-fai Cheung, MBBS*,*,
Tak-cheung Yung, MBBS*,
Sidney C. F. Tam, MBBS ,
Marco H. K. Ho, MBBS* and
Adolphus K. T. Chau, MBBS*
* Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Grantham Hospital, University of Hong Kong, Hong Kong, China
Division of Clinical Biochemistry, Queen Mary Hospital, Hong Kong, China
Manuscript received February 26, 2003;
revised manuscript received June 19, 2003,
accepted August 5, 2003.
* Reprint requests and correspondence: Dr. Yiu-fai Cheung, Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Grantham Hospital, University of Hong Kong, 125 Wong Chuk Hang Road, Hong Kong, China.
xfcheung{at}hkucc.hku.hk
OBJECTIVES: We determined the profile of cardiovascular risk factors in children late after Kawasaki disease (KD) and compared it with that of age-matched healthy children.
BACKGROUND: Concerns have been raised regarding the possibility of a predisposition of KD to premature atherosclerosis later in life.
METHODS: A cohort of 102 subjects were studied: 37 KD patients with coronary aneurysms (group I), 29 KD patients with normal coronary arteries (group II), and 36 healthy age-matched children (group III). The fasting total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, apolipoprotein (apo) A-I, apoB, and homocysteine levels were compared among the three groups. In addition, blood pressure and brachioradial arterial stiffness, as determined by pulse wave velocity (PWV), were measured and compared.
RESULTS: Group I subjects had lower HDL cholesterol (p = 0.016) and apoA-I levels (p = 0.044) and higher apoB levels (p = 0.029) and PWV (p = 0.001) than group III control subjects. Likewise, the apoB levels (p = 0.007) and PWV (p = 0.042) were higher in group II than in III subjects, although their HDL cholesterol (p = 0.54) and apoA-I (p = 0.52) levels were similar. The LDL cholesterol levels were higher in group I and II patients than in controls, although not statistically significant (p = 0.17). Blood pressure and homocysteine levels did not differ among the groups.
CONCLUSIONS: An adverse cardiovascular risk profile, as characterized by a proatherogenic alteration of the lipid profile and increased arterial stiffness, occurs in children after KD. The profile is worse in those with than in those without coronary aneurysms.
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Abbreviations and Acronyms
| | ANOVA | = analysis of variance | | apo | = apolipoprotein | | BP | = blood pressure | | HDL | = high-density lipoprotein | | KD | = Kawasaki disease | | LDL | = low-density lipoprotein | | MTHFR | = methylenetetrahydrofolate reductase | | PWV | = pulse wave velocity |
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