One-year follow-up of cardiac and coronary artery disease in infants and children with Kawasaki disease

1988 ◽  
Vol 115 (6) ◽  
pp. 1263-1267 ◽  
Author(s):  
Kyung J Chung ◽  
David R Fulton ◽  
Richard Lapp ◽  
Stephen Spector ◽  
David J Sahn
Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Abdulhamied Alfaddagh ◽  
Francine K Welty

Introduction: Poor physical function impairs fitness and is associated with worse cardiovascular outcomes and all-cause mortality. Arthritis and joint dysfunction limit physical function in coronary artery disease (CAD) patients. Hypothesis: Omega-3 fatty acids (FA) improve physical function in CAD patients through reducing inflammation. Methods: We randomized 249 subjects with stable CAD to 3.6 of omega-3 FA (1.86 g of eicosapentaenoic acid + 1.5 g of docosahexaenoic acid) per day or no omega-3 (control) for one year. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to evaluate pain, stiffness and physical function at baseline and one year follow-up. Inflammation was assessed by total white blood cell (WBC) count and its subsets as well as urine microalbumin-creatinine ratio (MCR). Results: Mean age was 63.0 ± 7.58 years; 17% were women. Controls had worsening stiffness (% Δ = 8.4%; p = 0.036) at 1 year follow-up while those on omega-3 FA had no change (% Δ = 0.4%, p = 0.886 - see Table)(a lower percent change indicates better functioning). Compared to controls, those on omega-3 FA had better physical function (% Δ = 8.5% vs. -2.8%, p = 0.011), and total WOMAC scores (% Δ = 7.8% vs. -2.5%, p = 0.011) and a significant decrease in WBC (% Δ = -3.5 vs. -9.4%; p=0.009) and neutrophils (% Δ = -3.5% vs. -11.6%; p=0.005) at one year follow-up. MCR significantly worsened only in the control group (% Δ = 53.3%, p = 0.037) at one year follow-up (p-value for control vs. omega-3 FAs groups = 0.026). Monocytes were decreased in the omega-3 FAs group at one year compared to baseline (% Δ = -11.1%, p < 0.001) and directly correlated with physical function and total scores (p = 0.033 and p = 0.024, respectively). Conclusions: Omega-3 FAs attenuate worsening of physical function over a one year period in CAD patients possibly mediated through an anti-inflammatory effect. Therefore, omega-3 FA may benefit CAD patients by improving their physical function.


Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Dharshan K Lakshminarayan ◽  
Tarec K Elajami ◽  
Michael Soliman ◽  
Abdulhamied Alfaddagh ◽  
Francine K Welty

Introduction: Microalbuminuria is a marker of generalized endothelial dysfunction, a key step in the pathogenesis of coronary artery disease (CAD). It is also an independent predictor of cardiovascular morbidity and mortality. Angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy is considered a standard of care to attenuate progression of albuminuria in diabetic patients. Hypothesis: Omega-3 fatty acids (FAs) supplementation will attenuate progression of microalbuminuria in diabetic subjects with stable CAD. Method: In our study, 262 subjects with stable CAD were randomized to 3.6 g of omega-3 FAs (1.86 g of eicosapentaenoic acid + 1.5 g of docosahexaenoic acid) per day or no omega-3 FA (control) for one year. Urine microalbumin to creatinine ratio (urine MCR mg/g) was calculated as a measure of microalbuminuria at baseline and one year follow-up. Results: Mean age was 63.3 ± 7.6 yrs, 17% were women, 30% had diabetes, and 74% were on ACEI or ARB therapy. At one year follow-up in non-diabetics, there was no significant difference in the % change in urine MCR between the omega-3 FAs and control groups (see table). In contrast in diabetics, those not receiving omega-3 FAs had a significant 72.3% increase in urine MCR whereas those receiving omega-3 FAs had no change (table). In subgroup analysis, diabetics on an ACEI or ARB receiving omega-3 FAs had no change in urine MCR whereas those not receiving omega-3 FAs had a 64.2% increase at one year follow-up. Conclusions: Omega-3 FAs attenuated worsening of urine MCR in diabetics with CAD compared to diabetics not receiving omega-3 FAs over a one year period. Our results suggest that a combination of omega-3 FAs and ACEI or ARB is better in attenuating the progression of microalbuminuria than ACEI or ARB alone in diabetics with CAD. This suggests that omega-3 FAs may provide additional benefit when added to ACEI/ARB in diabetics with CAD.


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