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Prevalence and predictors of coronary artery disease in adults with Kawasaki disease

Published online by Cambridge University Press:  23 October 2014

Jalaj Garg
Affiliation:
Department of Internal Medicine, Division of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York, United States of America
Parasuram Krishnamoorthy
Affiliation:
Department of Internal Medicine, Mount Sinai Englewood Hospital and Medical Center, Englewood, New Jersey, United States of America
Chandrasekar Palaniswamy
Affiliation:
Department of Internal Medicine, Division of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York, United States of America
Rajiv Paudel
Affiliation:
Department of Internal Medicine, Division of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York, United States of America
Saurav Chatterjee*
Affiliation:
Division of Cardiology, St. Luke’s Roosevelt Hospital, Mount Sinai Medical Center, New York, New York, United States of America
Hasan Ahmad
Affiliation:
Department of Internal Medicine, Division of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York, United States of America
Christopher Snyder
Affiliation:
Department of Pediatrics, Division of Cardiology, Case Western Reserve School of Medicine, Rainbow Babies and Children’s Hospital, Cleveland, Ohio, United States of America
*
Correspondence to: S. Chatterjee, MD, Division of Cardiology St. Luke’s Roosevelt Hospital Centre, Mount Sinai Medical Center, New York, NY 10025, United States of America. Tel: 418 988 0084; Fax: 347 244 7148; Email: [email protected]

Abstract

Background: Accelerated coronary atherosclerosis in patients with Kawasaki disease, in conjunction with coronary artery aneurysm and stenosis that characterise this disease, are potential risk factors for developing coronary artery disease in young adults. We aimed to determine the prevalence and predictors of coronary artery disease in adult patients with Kawasaki disease. Methods: All patients aged 18−55 years of age diagnosed with Kawasaki disease were sampled from Nationwide Inpatient Sample database using International Classification of Diseases 9th revision (ICD 9 code 446.1) from 2009 to 2010. Demographics, prevalence of coronary artery disease, and other traditional risk factors in adult patients with Kawasaki disease were analysed using ICD 9 codes. Results: The prevalence of Kawasaki disease among adults was 0.0005% (n=215) of all in-hospital admissions in United States. The mean age was 27.3 years with women (27.6 years) older than men (27.1 years). Traditional risk factors were hypertension (21%), hyperlipidaemia (15.6%), diabetes (11.5%), tobacco use (8.8%), and obesity (8.8%), with no significant difference between men and women. Coronary artery disease (32.4%), however, was more prevalent in men (44.7%) than in women (12.1%; p=0.03). In multivariate regression analysis, after adjusting for demographics and traditional risk factors, hypertension (OR=13.2, p=0.03) was an independent risk factor of coronary artery disease. Conclusion: There was increased preponderance of coronary artery disease in men with Kawasaki disease. On multivariate analysis, hypertension was found to be the only independent predictor of coronary artery disease in this population after adjusting for other risk factors.

Type
Original Articles
Copyright
© Cambridge University Press 2014 

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References

1. Kawasaki, T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Arerugi 1967; 16: 178222.Google Scholar
2. Newburger, JW, Takahashi, M, Gerber, MA, 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. Circulation 2004; 110: 27472771.Google Scholar
3. Taubert, KA, Rowley, AH, Shulman, ST. Nationwide survey of Kawasaki disease and acute rheumatic fever. J Pediatr 1991; 119: 279282.Google Scholar
4. Kato, H, Inoue, O, Kawasaki, T, et al. Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation 1996; 94: 13791385.Google Scholar
5. Burns, JC, Shike, H, Gordon, JB, et al. Sequelae of Kawasaki disease in adolescents and young adults. J Am Coll Cardiol 1996; 28: 253257.Google Scholar
6. Akagi, T, Rose, V, Benson, LN, et al. Outcome of coronary artery aneurysms after Kawasaki disease. J Pediatr 1992; 121: 689694.CrossRefGoogle ScholarPubMed
7. Gordon, JB, Kahn, AM, Burns, JC. When children with Kawasaki disease grow up: myocardial and vascular complications in adulthood. J Am Coll Cardiol 2009; 54: 19111920.Google Scholar
8. Fukazawa, R, Ikegam, E, Watanabe, M, et al. Coronary artery aneurysm induced by Kawasaki disease in children show features typical senescence. Circ J 2007; 71: 709715.CrossRefGoogle ScholarPubMed
9. Sugimura, T, Kato, H, Inoue, O, et al. Intravascular ultrasound of coronary arteries in children. Assessment of the wall morphology and the lumen after Kawasaki disease. Circulation 1994; 89: 258265.Google Scholar
10. Mitani, Y, Ohashi, H, Sawada, H, et al. In vivo plaque composition and morphology in coronary artery lesions in adolescents and young adults long after Kawasaki disease: a virtual histology-intravascular ultrasound study. Circulation 2009; 119: 28292836.CrossRefGoogle Scholar
11. Rosenfeld, EA, Corydon, KE, Shulman, ST. Kawasaki disease in infants less than one year of age. J Pediatr 1995; 126: 524529.Google Scholar
12. Terai, M, Shulman, ST. Prevalence of coronary artery abnormalities in Kawasaki disease is highly dependent on gamma globulin dose but independent of salicylate dose. J Pediatr 1997; 131: 888893.Google Scholar
13. de Magalhaes, CM, Alves, NR, de Melo, AV, et al. Catastrophic Kawasaki disease unresponsive to IVIG in a 3-month-old infant: a diagnostic and therapeutic challenge. Pediatr Rheumatol Online J 2012; 10: 28. doi:10.1186/1546-0096-10-28.CrossRefGoogle Scholar
14. Tremoulet, AH, Pancoast, P, Franco, A, et al. Calcineurin inhibitor treatment of intravenous immunoglobulin-resistant Kawasaki disease. J Pediatr 2012; 161: 506512.Google Scholar
15. Uehara, R, Belay, ED, Maddox, RA, et al. Analysis of potential risk factors associated with nonresponse to initial intravenous immunoglobulin treatment among Kawasaki disease patients in Japan. Pediatr Infect Dis J 2008; 27: 155160.CrossRefGoogle ScholarPubMed
16. Nakamura, Y, Yashiro, M, Uehara, R, et al. Increasing incidence of Kawasaki disease in Japan: nationwide survey. Pediatr Int 2008; 50: 287290.CrossRefGoogle ScholarPubMed
17. Nakamura, Y, Yashiro, M, Uehara, R, et al. Epidemiologic features of Kawasaki disease in Japan: results of the 2007–2008 nationwide survey. J Epidemiol 2010; 20: 302307.Google Scholar
18. Wu, MH, Chen, HC, Yeh, SJ, et al. Prevalence and the long-term coronary risks of patients with Kawasaki disease in a general population <40 years: a national database study. Circ Cardiovasc Qual Outcomes 2012; 5: 566570.CrossRefGoogle Scholar
19. Samaan, SA, Crawford, MH. Estrogen and cardiovascular function after menopause. J Am Coll Cardiol 1995; 26: 14031410.Google Scholar
20. Rossouw, JE. Estrogens for prevention of coronary heart disease. putting the brakes on the bandwagon. Circulation 1996; 94: 29822985.Google Scholar
21. Tsuda, E, Abe, T, Tamaki, W. Acute coronary syndrome in adult patients with coronary artery lesions caused by Kawasaki disease: review of case reports. Cardiol Young 2011; 21: 7482.CrossRefGoogle ScholarPubMed
22. Muneuchi, J, Joo, K, Morihana, E, et al. Detectable silent calcification in a regressed coronary artery aneurysm of a young adult with a history of Kawasaki disease. Pediatr Cardiol 2008; 29: 195197.Google Scholar
23. Takahashi, K, Oharaseki, T, Naoe, S, et al. Neutrophilic involvement in the damage to coronary arteries in acute stage of Kawasaki disease. Pediatr Int 2005; 47: 305310.Google Scholar
24. Vlachopoulos, C, Aznaouridis, K, Stefanadis, C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol 2010; 55: 13181327.Google Scholar
25. Laurent, S, Cockcroft, J, Bortel, LV, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006; 27: 25882605.CrossRefGoogle ScholarPubMed
26. Oishi, Y, Miyoshi, H, Mizuguchi, Y, et al. Aortic stiffness is strikingly increased with age >/= 50 years in clinically normal individuals and preclinical patients with cardiovascular risk factors: assessment by the new technique of 2D strain echocardiography. J Cardiol 2011; 57: 354359.CrossRefGoogle ScholarPubMed
27. Nurnberger, J, Keflioglu-Scheiber, A, Opazo Saez, AM, et al. Augmentation index is associated with cardiovascular risk. J Hypertens 2002; 20: 24072414.CrossRefGoogle ScholarPubMed
28. Tobayama, H, Takahashi, K, Fukunaga, H, et al. Analysis of arterial function in adults with a history of Kawasaki disease. J Cardiol 2013; 61: 330335.Google Scholar
29. Vogel, RA, Corretti, MC. Estrogens, progestins, and heart disease: can endothelial function divine the benefit? Circulation 1998; 97: 12231226.Google Scholar
30. Chatzizisis, YS, Coskun, AU, Jonas, M, et al. Role of endothelial shear stress in the natural history of coronary atherosclerosis and vascular remodeling: molecular, cellular, and vascular behavior. J Am Coll Cardiol 2007; 49: 23792393.CrossRefGoogle ScholarPubMed
31. Forstermann, U, Closs, EI, Pollock, JS, et al. Nitric oxide synthase isozymes. Characterization, purification, molecular cloning, and functions. Hypertension 1994; 23: 11211131.Google Scholar
32. Cai, H, Harrison, DG. Endothelial dysfunction in cardiovascular diseases: the role of oxidant stress. Circ Res 2000; 87: 840844.Google Scholar
33. Tomasian, D, Keaney, JF, Vita, JA. Antioxidants and the bioactivity of endothelium-derived nitric oxide. Cardiovasc Res 2000; 47: 426435.CrossRefGoogle ScholarPubMed
34. Ikemoto, Y, Ogino, H, Teraguchi, M, et al. Evaluation of preclinical atherosclerosis by flow-mediated dilatation of the brachial artery and carotid artery analysis in patients with a history of Kawasaki disease. Pediatr Cardiol 2005; 26: 782786.CrossRefGoogle ScholarPubMed
35. Kadono, T, Sugiyama, H, Hoshiai, M, et al. Endothelial function evaluated by flow-mediated dilatation in pediatric vascular disease. Pediatr Cardiol 2005; 26: 385390.Google Scholar
36. Dhillon, R, Clarkson, P, Donald, AE, et al. Endothelial dysfunction late after Kawasaki disease. Circulation 1996; 94: 21032106.Google Scholar
37. Noto, N, Okada, T, Karasawa, K, et al. Age-related acceleration of endothelial dysfunction and subclinical atherosclerosis in subjects with coronary artery lesions after Kawasaki disease. Pediatr Cardiol 2009; 30: 262268.Google Scholar
38. Wilson, PW, D’Agostino, RB, Levy, D, et al. Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97: 18371847.Google Scholar
39. Zhang, Y, Lelong, H, Kretz, S, et al. Characteristics and future cardiovascular risk of patients with not-at-goal hypertension in general practice in France: the AVANT’AGE study. J Clin Hypertens (Greenwich) 2013; 15: 291295.CrossRefGoogle ScholarPubMed
40. Ross, R. The pathogenesis of atherosclerosis: a perspective for the 1990s. Nature 1993; 362: 801809.CrossRefGoogle ScholarPubMed