Long-Term Cardiovascular Consequences of Kawasaki Disease

The major adverse consequence of Kawasaki disease (KD) is coronary-artery aneurysm formation. Newburger and colleagues' study demonstrating that intravenous immune globulin (IVIG) treatment reduces the aneurysm rate was published in 1986 (N Engl J Med 1986; 315:341); subsequently, such treatment became the standard of care. Few data are available on the long-term outcomes of KD in a U.S. population during the post-IVIG treatment era.

In a recent retrospective cohort study, researchers used the medical records of Kaiser Permanente Northern California — a group health practice with >3.2 million members — to examine outcomes of KD survivors. Members aged ≥15 years with a history of KD at age ≤5 years were matched to controls without KD in a 4:1 ratio.

Among 546 KD case-patients with follow-up of ≥1 year, 79% were treated with IVIG. For most of the patients, KD was diagnosed between 1990 and 1998. Thirteen percent had some degree of coronary enlargement during the acute stage, but only 5% had persistent aneurysms. During a mean follow-up of 14.9 years, cardiovascular adverse event rates were similar between the KD patients and controls. Among the KD patients with persistent aneurysms were five children with serious long-term complications, including sudden cardiac death. KD patients were slightly more likely than controls to develop hypertension, which may be a result of arterial stiffness following inflammation.