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 RHEUMATOLOGY NEWS.
The findings suggest that 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 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],” he said at the symposium.
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. They also enrolled a group of 60 normal controls matched for age and gender.
The investigators performed a cardiovascular risk assessment of all participants. Systemic arterial endothelial function was obtained to assess 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 groups in total cholesterol; HDL; LDL; apolipoproteins A-1, 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.