Significant Relationship Between Serum High-sensitivity C-Reactive Protein, High-density Lipoprotein Cholesterol Levels and Children With Kawasaki Disease and Coronary Artery Lesions

Ou, Chien Hui; Tseng, Yu-Fang; Lee, Cheng-Liang; Chiou, Yee-Hsuan; Hsieh, Kai‐Sheng

doi:10.1016/s0929-6646(09)60395-8

Cited by 30 publications

(15 citation statements)

References 16 publications

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“…341 Although they are improved after convalescence, lower HDL cholesterol levels can persist, particularly in those patients with severe and ongoing coronary artery aneurysms. 338,342,343 HDL and inflammation are known to be interrelated, and chronic changes may reflect this relationship. Nuclear magnetic resonance lipoprotein particle analysis suggests that pediatric and adult patients with KD, regardless of their aneurysm status, are no more likely than age-similar, healthy control subjects to have lipid patterns associated with increased risk of atherosclerosis.…”

Section: Risk Factors In Kd Patientsmentioning

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

2,606

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: Risk Factors In Kd Patientsmentioning

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

2,606

4,124

View full text Add to dashboard Cite

show abstract

“…Some researches indicate that vascular inflammation manifests as elevated levels of high sensitive C- reactive protein (hs-CRP) and persists for two many years after an acute phase of KD in coronary complicated cases. [ 8 11 12 ] Although others revealed no evidence of vascular inflammation years after uncomplicated KD. [ 4 ] To the best of our knowledge, the present study is the first one that has investigated the persistence of vascular cell damage by the number of CECs, several years after subsiding, in the acute phase of the disease.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies indicate persistently elevated serum markers of inflammation, such as high-sensitivity C-reactive protein (hs-CRP), in coronary complicated KD patients, late after the involvement, which suggests chronic low-grade vascular inflammation in these patients. [ 8 11 12 ] Studies on uncomplicated KD patients sometimes show no significant increase in these markers. [ 4 ] Endothelial cells (ECs) consist of a huge population of cells that play a crucial role in preserving vascular homeostasis.…”

Section: Introductionmentioning

confidence: 99%

Persistence of endothelial cell damage late after Kawasaki disease in patients without coronary artery complications

et al. 2015

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Background:Recent studies proposed an increased risk of atherosclerosis in patients with a history of Kawasaki disease. This study aimed to investigate the persistence of vascular injury after an acute phase of the Kawasaki disease.Materials and Methods:We determined the number of circulating endothelial cells (CEC) in the peripheral blood of 13 patients with a history of Kawasaki disease within four to ten years, in comparison with 13 healthy relative controls. The CECs were counted as CD146+/CD34 + cells by the standard flow cytometry technique, and the independent t-test was employed to compare the mean number of CECs in the two groups.Results:The mean number of CECs was significantly higher in patients than in controls (12 ± 3.03 vs. 2.38 ± 0.87, respectively, P < 0.001).Conclusion:This study elucidates the persistence of vascular injury late after Kawasaki disease. This finding suggests that prolonged administration of vascular anti-inflammatory agents might be beneficial for preventing atherosclerosis in the subsequent years, in these patients.

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“…In their follow-up of KD patients at a mean of 7 years after KD, Cheung et al5) demonstrated that patients with CAL had reduced not only HDL-C, but also Apo-A and all risk factors for cardiovascular disease. Yet, inconsistent correlation between lipid profile and the degree of early atherosclerosis have been reported in adolescent and young adult after KD6,8,9,10,15). McCrindle et al10) showed that KD patients with 10 to 20 years of age had lower Apo-A levels than those in the healthy control subjects in 2007.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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PurposeThe aim of this study was to determine whether school-aged children with Kawasaki disease (KD) have an increased risk for early atherosclerosis.MethodsThe 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, high-sensitivity C-reactive protein (hs-CRP), and brachial artery stiffness using pulse wave velocity were compared among the three groups.ResultsThere 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).ConclusionSchool-aged children after KD have high lipid profiles and arterial stiffness indicating an increased risk for early atherosclerosis.

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Significant Relationship Between Serum High-sensitivity C-Reactive Protein, High-density Lipoprotein Cholesterol Levels and Children With Kawasaki Disease and Coronary Artery Lesions

Cited by 30 publications

References 16 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

Persistence of endothelial cell damage late after Kawasaki disease in patients without coronary artery complications

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

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