Noninvasive assessment of the early progression of atherosclerosis in adolescents with Kawasaki disease and coronary artery lesions

Objectives. The severity of carotid arteriosclerosis, defined as increased intima-media thickness (IMT) visible with B-mode ultrasound, is correlated with risk factors for coronary heart disease. Little is known, however, abo ut the relation of IMT, the stiffness of the common carotid artery, and the progression of atherosclerosis in children with Kawasaki disease (KD) and coronary artery lesions (CAL). Design. We investigated the associations among total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholester ol (LDL-C), triglyceride, TC/HDL-C, ApoE genotype, glycohemoglobin, IMT, an d arterial stiffness by high resolution ultrasound in 20 adolescents with K D and CAL (age: 16.6 +/- 4.1 years, males: 60%) and 20 sex- and age-matched healthy controls (Cont). Results. No significant differences were observed in the values of body mas s index and blood pressure between the 2 groups. Also no significant differ ences were observed in the levels of TC, LDL-C, HDL-C, triglyceride, TC/HDL -C within normal values, or the allele frequency of Apo E4 between the 2 gr oups. However, the values of IMT, stiffness, and glycohemoglobin in patient s with KD were significantly higher than those in Cont (0.53 +/- 0.07 vs 0. 46 +/- 0.05 mm, P < .05; 4.11 <plus/minus> 0.86 vs 2.94 +/- 0.91, P < .001; 5.0 <plus/minus> 0.4 vs 4.6 +/- 0.2%, P < .05). A significant relationship was observed between sex and the mean IMT (r = 0.46) in Cont; however, no significant correlation was found between mean IMT and other variables in e ither group. Although the arterial stiffness was strongly related to body m ass index (r = 0.58) and systolic blood pressure (r = 0.55) in Cont, no sig nificant relationship was observed between the stiffness and any variable t ested in patients with KD. Conclusions. The less distensible carotid wall in patients with KD compared with that in Cont without major alteration of the lipid profile is likely to be secondary to the changes in arterial walls after a diffuse vasculitis involving noncoronary arteries. These results indicate that the coronary a rteries may be predisposed to accelerated atherosclerosis in patients with KD and CAL.