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Background  Kawasaki disease ( KD ) is a pediatric vasculitis with coronary artery aneurysm ( CAA ) as a major complication. Controversy exists about cardiovascular risk later in life. The aim of our study was to evaluate whether  KD  patients are at increased risk, as assessed by carotid intima‐media thickness ( cIMT ).    Methods and Results  We measured  cIMT  over 15 years by B‐mode ultrasonography in  KD  patients during follow‐up and in unaffected controls (mostly siblings). A multilevel, repeated‐measures, linear mixed‐effects model was used to evaluate the association between  KD  and  cIMT . A total of 319 patients with 528 measurements were compared with 150 controls. In  KD  patients, the mean  cIMT  was increased compared with controls (0.375 mm [95%  CI  0.372–0.378 mm] versus 0.363 mm [95%  CI  0.358–0.368 mm];  P <0.001). Furthermore, mean  cIMT  of  CAA ‐negative patients was 0.373 mm ( P <0.01 compared with controls), of patients with small–medium  CAA  was 0.374 mm ( P <0.05 compared with controls), and of patients with giant  CAA  was 0.381 mm ( P <0.01 compared with controls). Compared with controls,  CAA ‐negative participants started with an increased  cIMT  (+0.0193±0.0053 mm,  P <0.001) but showed slower progression (−0.0014±0.0006 mm/year,  P =0.012). Patients with giant  CAA  showed a trend toward increased  cIMT  progression (0.0013±0.0007 mm/year,  P =0.058).    Conclusions  We observed a positive correlation between  cIMT  and  KD  severity of coronary arteritis at the acute stage. Although initially increased, the  cIMT  in  CAA ‐negative patients normalized at a later age. In contrast, patients with a history of  KD  complicated by giant  CAA  showed a trend toward persistently increased  cIMT . These patients may need cardiovascular counseling and follow‐up beyond the heart.

Extracardial Vasculopathy After Kawasaki Disease: A Long‐Term Follow‐up Study