From the Guidelines
Individuals who had Kawasaki disease in childhood should maintain regular cardiac follow-up throughout adulthood to monitor for potential long-term cardiovascular complications, such as coronary artery aneurysms, which can increase the risk of morbidity and mortality. The primary concern is coronary artery aneurysms, which developed in approximately 25% of untreated cases before IVIG therapy became standard 1. Even with proper treatment, about 5% of patients may develop these aneurysms 1. Adults who had Kawasaki disease with documented coronary artery abnormalities should undergo periodic cardiac imaging (echocardiogram or cardiac CT/MRI) every 3-5 years and stress testing as recommended by their cardiologist. Those who had severe coronary involvement may need antiplatelet therapy (aspirin 81mg daily) or anticoagulation (warfarin with target INR 2.0-3.0) indefinitely.
Some key points to consider in the management of adults with a history of Kawasaki disease include:
- Regular cardiac follow-up to monitor for coronary artery aneurysms and other cardiovascular complications
- Adoption of heart-healthy lifestyles, including regular exercise, healthy diet, avoiding smoking, and controlling blood pressure and cholesterol
- Consideration of antiplatelet or anticoagulation therapy for those with severe coronary involvement
- Periodic cardiac imaging and stress testing to monitor for potential complications
According to the American Heart Association, the long-term prognosis is determined by the initial and current level of coronary artery involvement 1. Certain subsets of patients are at risk for myocardial ischemia from coronary artery thrombosis and stenoses, and medical management of such patients hinges on judicious use of thromboprophylaxis and vigilance to identify evolving stenoses. Regular cardiac follow-up and adoption of heart-healthy lifestyles are crucial to minimizing the risk of morbidity and mortality in adults with a history of Kawasaki disease.
From the Research
Potential Risks in Adulthood
Kawasaki disease, a self-limited childhood systemic vasculitis, can have long-term effects on the coronary arteries, potentially leading to complications in adulthood. Some key points to consider include:
- Coronary artery aneurysms, which can occur in approximately 20% of patients without treatment 2, can increase the risk of thrombosis, stenosis, and myocardial infarction.
- The risk of myocardial infarction from coronary artery thrombosis is greatest in the first 2 years after illness onset, but stenosis and occlusion can progress over years 3.
- Kawasaki disease is no longer a rare cause of acute coronary syndrome presenting in young adults, highlighting the need for ongoing monitoring and care 3.
Ongoing Monitoring and Care
To mitigate potential risks, individuals who had Kawasaki disease in childhood should:
- Undergo regular echocardiography to assess the presence of coronary artery dilatation or aneurysm formation 4.
- Be aware of the signs and symptoms of coronary artery disease, such as chest pain or shortness of breath.
- Maintain a healthy lifestyle, including a balanced diet and regular exercise, to reduce the risk of cardiovascular disease.
Treatment and Management
Effective therapies exist for most patients with acute Kawasaki disease, including aspirin and intravenous immunoglobulins (IVIG) as first-line therapies 4. In cases where these treatments are not effective, other options such as intravenous pulsed doses of methylprednisolone or infliximab may be considered 4. For patients who develop coronary artery aneurysms or stenosis, coronary artery bypass surgery or percutaneous intervention may be necessary 3.