An Update on Cardiovascular Risk Factors After Kawasaki Disease

Abstract

First described in Japan 50 years ago, Kawasaki disease is a worldwide multisystem disease. It is an acute self-limited vasculitis of unknown etiology that can lead to coronary artery lesions, such as dilatation, aneurysms, and stenosis in children. It is one of the common causes of acquired heart disease among children in developed countries. The coronary aneurysm is a severe complication in the acute stage, possibly leading to stenotic lesions or myocardial ischemia. More concerns have centered on endothelial damage and the early onset of atherosclerosis in patients with KD. Although the coronary artery aneurysm is small or degenerated, the vascular structure does not return to normal, vascular endothelial dysfunction and remodeling continue. Most patients diagnosed with coronary artery sequelae are at risk of long-term complications. There are still many unknown aspects regarding the long-term prognosis of patients. Concerns have centered on the early onset of atherosclerosis in patients with KD. There is still no consensus on the relationship between Kawasaki disease and atherosclerosis. This study aimed to evaluate if patients with a history of KD were at risk of accelerated atherosclerosis.

Changes in the cardiovascular system in children with pediatric multisystem inflammatory syndrome temporally associated with COVID-19 – A single center experience

“…Most of the patients in the study group had abnormalities in the lipid profile, most often in the form of high triglyceride levels and low high-density lipoprotein (HDL) levels ( 22 ). It is worth emphasizing that among the ionic disturbances in children with PIMS, there are also visible disturbances in vitamin D3 concentration.…”

“…The role of vitamin D3 as a protective factor for the circulatory system has been emphasized in the literature for many years. The long-term effects of low vitamin D3 levels and the abnormalities in the lipid profile found in PIMS-TS syndrome may predispose to the earlier development of atherosclerosis or heart failure in these patients ( 22 , 23 ).…”

Kawasaki Disease-like Vasculitis Facilitates Atherosclerosis, and Statin Shows a Significant Antiatherosclerosis and Anti-Inflammatory Effect in a Kawasaki Disease Model Mouse

“…Of these patients, 150,000 were over 20 years of age, and 15,000 were over 40 years (from 1964 to 31 December 2016) [ 2 , 3 ]. Among adult patients with KD, it has been reported that vasculitis might induce the early progression of atherosclerosis [ 4 , 5 , 6 ]. The pathological image of chronic KD cardiovascular sequelae is mainly composed of sclerotic lesions after vasculitis, which is pathologically different from usual atherosclerotic lesions [ 6 , 7 ].…”

“…Among adult patients with KD, it has been reported that vasculitis might induce the early progression of atherosclerosis [ 4 , 5 , 6 ]. The pathological image of chronic KD cardiovascular sequelae is mainly composed of sclerotic lesions after vasculitis, which is pathologically different from usual atherosclerotic lesions [ 6 , 7 ]. However, it has been demonstrated that chronic vascular endothelial cell damage persists in patients with KD due to the tissue infiltration of inflammatory cells such as macrophage and activation of the immune system by releasing inflammatory cytokines [ 5 , 6 , 8 ].…”

“…The pathological image of chronic KD cardiovascular sequelae is mainly composed of sclerotic lesions after vasculitis, which is pathologically different from usual atherosclerotic lesions [ 6 , 7 ]. However, it has been demonstrated that chronic vascular endothelial cell damage persists in patients with KD due to the tissue infiltration of inflammatory cells such as macrophage and activation of the immune system by releasing inflammatory cytokines [ 5 , 6 , 8 ]. Endothelial dysfunction could be said to share a common ground with ordinary atherosclerosis [ 5 , 6 , 8 , 9 ].…”