Cardiovascular risk factors of early atherosclerosis in school-aged children after Kawasaki disease

  • Cho, Hyun Jeong (Department of Pediatrics, Chungnam National University School of Medicine) ;
  • Yang, Soo In (Department of Pediatrics, Chungnam National University School of Medicine) ;
  • Kim, Kyung Hee (Department of Pediatrics, Chungnam National University School of Medicine) ;
  • Kim, Jee Na (Department of Pediatrics, Inje University College of Medicine) ;
  • Kil, Hong Ryang (Department of Pediatrics, Chungnam National University School of Medicine)
  • Received : 2013.09.15
  • Accepted : 2013.11.06
  • Published : 2014.05.15


Purpose: The aim of this study was to determine whether school-aged children with Kawasaki disease (KD) have an increased risk for early atherosclerosis. Methods: The study included 98 children. The children were divided into the following groups: group A (n=19), KD with coronary arterial lesions that persisted or regressed; group B (n=49), KD without coronary arterial lesions; and group C (n=30), healthy children. Anthropometric variables and the levels of biochemical markers, including total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A, apolipoprotein B, homocysteine, highsensitivity C-reactive protein (hs-CRP), and brachial artery stiffness using pulse wave velocity were compared among the three groups. Results: There were no significant differences in blood pressure and body index among the three groups. Additionally, there was no sex-specific difference. Moreover, the levels of triglyceride, HDL-C, apolipoprotein A, and hs-CRP did not differ among the three groups. However, the levels of total cholesterol (P =0.018), LDL-C (P =0.0003), and apolipoprotein B (P =0.029) were significantly higher in group A than in group C. Further, the level of homocysteine and the aortic pulse wave velocity were significantly higher in groups A and B than in group C (P=0.0001). Conclusion: School-aged children after KD have high lipid profiles and arterial stiffness indicating an increased risk for early atherosclerosis.



  1. Kato H, Sugimura T, Akagi T, Sato N, Hashino K, Maeno Y, et al. Long-term consequences of Kawasaki disease: a 10- to 21-year follow-up study of 594 patients. Circulation 1996;94:1379-85.
  2. Gersony WM. The adult after Kawasaki disease the risks for late coronary events. J Am Coll Cardiol 2009;54:1921-3.
  3. Burns JC, Shike H, Gordon JB, Malhotra A, Schoenwetter M, Kawasaki T. Sequelae of Kawasaki disease in adolescents and young adults. J Am Coll Cardiol 1996;28:253-7.
  4. Silva AA, Maeno Y, Hashmi A, Smallhorn JF, Silverman ED, McCrindle BW. Cardiovascular risk factors after Kawasaki disease: a case-control study. J Pediatr 2001;138:400-5.
  5. Cheung YF, Yung TC, Tam SC, Ho MH, Chau AK. Novel and traditional cardiovascular risk factors in children after Kawasaki disease: implications for premature atherosclerosis. J Am Coll Cardiol 2004;43:120-4.
  6. Mitani Y, Sawada H, Hayakawa H, Aoki K, Ohashi H, Matsumura M, et al. Elevated levels of high-sensitivity C-reactive protein and serum amyloid-A late after Kawasaki disease: association between inflammation and late coronary sequelae in Kawasaki disease. Circulation 2005;111:38-43.
  7. Iemura M, Ishii M, Sugimura T, Akagi T, Kato H. Long term consequences of regressed coronary aneurysms after Kawasaki disease: vascular wall morphology and function. Heart 2000;83:307-11.
  8. Dalla Pozza R, Bechtold S, Urschel S, Kozlik-Feldmann R, Netz H. Subclinical atherosclerosis, but normal autonomic function after Kawasaki disease. J Pediatr 2007;151:239-43.
  9. Gupta-Malhotra M, Gruber D, Abraham SS, Roman MJ, Zabriskie JB, Hudgins LC, et al. Atherosclerosis in survivors of Kawasaki disease. J Pediatr 2009;155:572-7.
  10. McCrindle BW, McIntyre S, Kim C, Lin T, Adeli K. Are patients after Kawasaki disease at increased risk for accelerated atherosclerosis? J Pediatr 2007;151:244-8.
  11. Cheung YF, Taylor MJ, Fisk NM, Redington AN, Gardiner HM. Fetal origins of reduced arterial distensibility in the donor twin in twin-twin transfusion syndrome. Lancet 2000;355:1157-8.
  12. Cabana VG, Gidding SS, Getz GS, Chapman J, Shulman ST. Serum amyloid A and high density lipoprotein participate in the acute phase response of Kawasaki disease. Pediatr Res 1997;42:651-5.
  13. Newburger JW, Burns JC, Beiser AS, Loscalzo J. Altered lipid profile after Kawasaki syndrome. Circulation 1991;84:625-31.
  14. Nishtar S, Wierzbicki AS, Lumb PJ, Lambert-Hammill M, Turner CN, Crook MA, et al. Waist-hip ratio and low HDL predict the risk of coronary artery disease in Pakistanis. Curr Med Res Opin 2004;20:55-62.
  15. Ou CY, Tseng YF, Lee CL, Chiou YH, Hsieh KS. Significant relationship between serum high-sensitivity C-reactive protein, high-density lipoprotein cholesterol levels and children with Kawasaki disease and coronary artery lesions. J Formos Med Assoc 2009;108:719-24.
  16. Goldberg IJ, Blaner WS, Vanni TM, Moukides M, Ramakrishnan R. Role of lipoprotein lipase in the regulation of high density lipoprotein apolipoprotein metabolism: studies in normal and lipoprotein lipase-inhibited monkeys. J Clin Invest 1990;86:463-73.
  17. Lakatos J, Harsagyi A. Serum total, HDL, LDL cholesterol, and triglyceride levels in patients with rheumatoid arthritis. Clin Biochem 1988;21:93-6.
  18. Linnebank M, Moskau S, Farmand S, Fliessbach K, Kolsch H, Bos M, et al. Homocysteine and carotid intima-media thickness in a german population: lack of clinical relevance. Stroke 2006; 37:2840-2.
  19. Koivistoinen T, Virtanen M, Hutri-Kahonen N, Lehtimaki T, Jula A, Juonala M, et al. Arterial pulse wave velocity in relation to carotid intima-media thickness, brachial flow-mediated dilation and carotid artery distensibility: the Cardiovascular Risk in Young Finns Study and the Health 2000 Survey. Atherosclerosis 2012;220:387-93.
  20. Noto N, Okada T, Yamasuge M, Taniguchi K, Karasawa K, Ayusawa M, et al. Noninvasive assessment of the early progression of atherosclerosis in adolescents with Kawasaki disease and coronary artery lesions. Pediatrics 2001;107:1095-9.
  21. Ishikawa T, Iwashima S. Endothelial dysfunction in children within 5 years after onset of Kawasaki disease. J Pediatr 2013;163:1117-21.
  22. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics 2004;114:1708-33.
  23. JCS Joint Working Group. Guidelines for diagnosis and management of cardiovascular sequelae in Kawasaki disease (JCS 2008): digest version. Circ J 2010;74:1989-2020.