Long-term CVD monitoring needed for children with Kawasaki disease
The risk for cardiovascular disease persists for 10 years after initial hospitalization among children with Kawasaki disease, according to data presented at the ACR Convergence 2020 virtual meeting.
Based on their results, researchers highlight the need for long-term cardiovascular surveillance and risk reduction strategies in this patient population.
Motivated by questions from patients’ families regarding future risk for heart disease during his first year of residency, Cal Robinson, MD, BSc, pediatric nephrology resident at The Hospital for Sick Children and University of Toronto, sought to learn more about cardiovascular outcomes among patients with childhood Kawasaki disease.
To do so, researchers used health administrative databases in Ontario to identify children aged 18 years who survived hospitalization for Kawasaki disease between 1995 and 2018. Only the first eligible hospitalization was included, and children with previously diagnosed Kawasaki disease and those who were not residents of Ontario were excluded.
Patients with Kawasaki disease were matched to 100 nonexposed controls based on age, sex and year, and all patients were followed until death, March 2019 or until 24 years of age. Rates of CVD, major adverse cardiac events (e.g., myocardial infarction and stroke) and death were determined and compared between groups from 0 to 1 year, 1 to 5 years, 5 to 10 years and 10 years post-hospitalization.
They identified 4,597 children diagnosed with Kawasaki disease, 746 of whom (16.2%) experienced cardiovascular events compared with 5.2% of controls. The most frequent events among Kawasaki disease survivors were ischemic heart disease (231 children, 4.6 events per 1,000 person years), arrythmias (229 children, 4.5 events per 1,000 person years), hypertension (159 children, 3.1 events per 1,000 person years) and peripheral vascular disease (107 children, 2.1 events per 1,000 person years).
Additionally, major adverse cardiac events occurred among 79 (1.7%) children with Kawasaki disease vs. 0.7% of controls. Nine patients died during the median 11-year follow-up period.
Survivors of Kawasaki disease had a higher risk for cardiac events compared with patients who did not have Kawasaki disease (ischemic heart disease and myocardial infarction: 5.4% vs. 0.7%), and they experienced their cardiovascular events sooner.
According to Robinson, the risk was highest in the first year after hospital discharge (HR = 14.13; 95% CI, 12.57-15.89). Throughout follow-up, survivors of Kawasaki disease had a higher risk for percutaneous coronary intervention or coronary artery bypass grafting (0.3%) vs. nonexposed patients (0.1%; HR = 14.68; 95% CI, 7.73-27.88). Interestingly, Robinson noted, throughout follow-up the risk for mortality was lower among survivors of Kawasaki disease vs. the control group (0.2% vs. 0.4%; HR = 0.42; 95% CI, 0.22-0.81).
“Our results provide additional information that can be helpful in counseling patients and families after a diagnosis of Kawasaki disease about their long-term prognosis, as well as the importance of taking steps early to reduce their risk for adult heart diseases, such as increasing their physical activity, implementing a heart healthy diet and avoiding smoking,” Robinson said during a press conference.
“Our results [also] justify additional follow-up and CVD surveillance in survivors of Kawasaki disease,” Robinson noted. “We know that in a universal health care system like the one we have in Ontario, most children with Kawasaki disease that don’t have initial coronary involvement would be discharged from pediatric or cardiac follow-up within a few months of their diagnosis. However, based on our results, we find that Kawasaki disease survivors may benefit from additional follow-up or surveillance for CVD risk factors such as obesity, high blood pressure and high cholesterol and if these risk factors were identified early, there could be modifications made to lifestyle or medication started to try and reduce their risk of later cardiac events.”
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Robinson C. Abstract #0937. Presented at: ACR Convergence 2020; November 5-9, 2020 (virtual meeting).
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