Effects of Statin Therapy in Children Complicated With Coronary Arterial Abnormality Late After Kawasaki Disease

Huang, Shiang‐Fen; Weng, Ken‐Pen; Chang, Jan‐Gowth; Lee, Wei-Yang; Huang, Shih-Hui; Hsieh, Kai‐Sheng

doi:10.1253/circj.cj-08-0121

Cited by 61 publications

(45 citation statements)

References 30 publications

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“…Short-term small studies in KD patients with aneurysms treated with statins have shown reductions in high-sensitivity CRP and improved endothelial function. [357][358][359] A review of empirical statin use in 20 KD patients as young as 8 months with aneurysms who were treated for a median of 2.5 years showed only transient laboratory abnormalities and no effect on growth. 360 Given this discussion, empirical treatment with low-dose statin may be considered for KD patients with past or current aneurysms, regardless of age or sex.…”

Section: Empirical Use Of Statinsmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,770

4,124

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BACKGROUND:Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS:To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and longterm outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS:These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances. K awasaki disease (KD) is an acute, self-limited febrile illness of unknown cause that predominantly affects children <5 years of age. When initially described, the potential for coronary artery complications was not appreciated. KD is now the most common cause of acquired heart disease in children in developed countries. In the absence of pathognomonic tests, the diagnosis continues to rest on the identification of principal clinical findings and the exclusion of other clinically similar entities with known causes. Timely initiation of treatment with intravenous immunoglobulin (IVIG) has reduced the incidence of coronary artery aneurysms defined from absolute luminal dimensions from 25% to ≈4%. Ongoing studies with additional therapies have not substantially reduced this residual risk. The long-term prognosis is determined by the initial and current level of coronary artery involvement. Certain subsets of patients are at risk for myocardial ischemia from coronary artery thrombosis and stenoses. Medical management of such patients hinges on judicious use of thromboprophylaxis and vigilance to identify evolving stenoses. Invasive revascul...

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Section: Empirical Use Of Statinsmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,770

4,124

View full text Add to dashboard Cite

show abstract

“…In this series, our data showed an effect of IL-1B polymorphism on IVIG resistance in KD treatment, which suggests the potential usefulness of monoclonal antibodies to IL-1 for IVIG-resistant patients, such as Anakinra. 32 Although some therapies, such as statins 33 and the combination of warfarin and aspirin, 34 might benefit KD patients with chronic CALs, it is still better to reduce the incidence of CALs during the acute stage. To date, no definite conclusions can be reached about the optimal treatment of patients at high risk for IVIG resistance, so prospective clinical trials are warranted to determine the role of these therapies, possibly including Anakinra.…”

Section: Discussionmentioning

confidence: 99%

IL-1B Polymorphism in Association With Initial Intravenous Immunoglobulin Treatment Failure in Taiwanese Children With Kawasaki Disease

Weng

Hsieh

et al. 2010

Circ J

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Background: Approximately 8-38% of children with Kawasaki disease (KD) will have persistent or recrudescent fever after initial intravenous immunoglobulin (IVIG) treatment and are at increased risk for development of coronary artery abnormalities. Using genetic markers may be helpful to identify the high-risk group of IVIG-resistant patients for aggressive treatment. The aim of this study was to evaluate the associations between 4 potential polymorphisms in the interleukin (IL)-1 family of genes and initial IVIG treatment failure in KD children. Methods and Results:A total of 156 KD children (136 with and 20 without a response to IVIG treatment) who were treated with high-dose IVIG (2 g/kg) within 10 days of fever onset were recruited. Polymerase chain reaction and Taqman assays were used for genotyping. A significant increase in IVIG resistance risk was observed for IL-1B −511 TT and IL-1B −31 CC genotypes (adjusted odds ratio (AOR) 5.27, 95% confidence interval (CI) 1.69-16.38, P=0.004; AOR 3.95, 95%CI 1.26-12.41, P=0.019, separately). The diplotype TC/TC (at IL-1B −511 and −31) also showed a significantly increased risk of IVIG resistance (AOR 4.32, 95%CI 1.36-13.71, P=0.013). Conclusions:The IL-1B −511 TT and IL-1B −31 CC genotypes or the TC/TC diplotype may be associated with initial IVIG treatment failure in Taiwanese children with KD. (Circ J 2010; 74: 544 - 551)

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“…10 Recent studies have shown that statins might have cholesterol-independent effects that include improving endothelial function, reducing vascular inflammation, inhibiting smooth muscle cell proliferation, an antithrombotic effect and immunomodulation. [25][26][27] In this regard, we demonstrated previously that statins reduce the onset of symptomatic congestive heart failure in addition to recurrent symptomatic myocardial ischemia in patients with AMI. 13 Taken together, it seems that statins could improve the prognosis of diabetic CHD patients through direct and pleiotropic effects.…”

Section: Discussionmentioning

confidence: 91%

Standard-Dose Statin Therapy Provides Incremental Clinical Benefits in Normocholesterolemic Diabetic Patients

Kojima

Sakamoto

Ogawa

et al. 2010

Circ J

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Effects of Statin Therapy in Children Complicated With Coronary Arterial Abnormality Late After Kawasaki Disease

Cited by 61 publications

References 30 publications

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

IL-1B Polymorphism in Association With Initial Intravenous Immunoglobulin Treatment Failure in Taiwanese Children With Kawasaki Disease

Standard-Dose Statin Therapy Provides Incremental Clinical Benefits in Normocholesterolemic Diabetic Patients

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