Meta-analysis: Lipids, vascular function, cardio-cerebrovascular events after previous Kawasaki disease in children.

BACKGROUND

Chronic vascular inflammation may persist after Kawasaki disease (KD), but the long-term cardio-cerebrovascular prognosis remains unclear. This study aimed to investigate the association between childhood KD and subsequent cardio-cerebrovascular risks.

METHODS

A meta-analysis was performed on observational studies from PubMed, Embase, and Web of Science that compared individuals with and without a history of KD, assessing outcomes including lipid profiles, vascular ultrasound indices, and cardio-cerebrovascular events using a random-effects model.

RESULTS

Fifty-one articles were meta-analyzed (46 on lipid and vascular markers, 5 on cardio-cerebrovascular events). Pooled analysis revealed reduced high-density lipoprotein cholesterol (HDLC) (weighted mean difference [WMD], 95% CI: -2.54, -4.31 to -0.77), impaired flow-mediated dilation (FMD) (WMD, 95% CI: -3.98, -5.78 to -2.17), increased carotid intima-media thickness (CIMT) (WMD, 95% CI: 0.03, 0.01-0.04), elevated ankle-brachial pulse wave velocity (BaPWV) (WMD, 95% CI: 46.00, 9.21-82.79), and a 4.4-fold increased risk (relative risk, 95% CI: 4.41, 4.02- 4.85) of cardio-cerebrovascular events vs controls. Subgroup analysis demonstrated reduced HDLC levels in patients with coronary artery lesions (CAL) (WMD, 95% CI: -3.70, -6.90 to -0.50) and Asian populations (WMD, 95% CI: -4.17, -6.86 to -1.47), along with FMD (with CAL: WMD, 95% CI: -7.01, -8.99 to -5.04; Asia: WMD, 95% CI: -5.60, -7.18 to -4.01) and increased CIMT (with CAL: WMD, 95% CI: 0.01, 0.00-0.02; Asia: WMD, 95% CI: 0.02, 0.01-0.03). Notably, reductions in both HDLC (WMD, 95% CI: -1.90, -2.39 to -1.40) and FMD (WMD, 95% CI: -5.29, -8.15 to -2.44) persisted in individuals over 10 years after KD.

CONCLUSION

This meta-analysis highlights that prior KD, regardless of CAL status, may confer lasting impairments in vascular homeostasis and dyslipidemia, potentially increasing the lifetime risk of developing cardio-cerebrovascular diseases.