Cardiovascular

Association between PM2.5 and coronary artery dilatation with Kawasaki disease in China.

Huang Z, Huang S, et al. • European journal of pediatrics • 2026

PubMed 42897330 DOI 10.1007/s00431-026-07527-9
TL;DR

PM2.5 exposure is a potential risk factor for coronary artery dilatation in children with Kawasaki disease, with CRP, alanine aminotransferase, and hemoglobin identified as the main mediators of the relationship between PM2.5 and CAD.

Key Findings

Results

Short-term PM2.5 exposure was associated with an increased risk of coronary artery dilatation (CAD) in children with Kawasaki disease at lags of 2-4 days.

  • Case-crossover study including 847 participants from 2017 to 2021 in China.
  • Coronary Z values were calculated for each participant and PM2.5 exposure levels were assigned.
  • Associations were assessed with a distributed lag Poisson generalized linear model.
  • Increased risk was observed at lag 2-4 days.
Results

The highest risk of CAD occurred at lag day 3 of PM2.5 exposure.

  • On the 3rd day of lag, PM2.5 exposure led to the highest CAD risk, with RR = 1.11 (95% CI = 1.02, 1.21).
Results

Mediation analysis identified C-reactive protein (CRP), alanine aminotransferase (ALT), and hemoglobin (HB) as significant mediators between PM2.5 and CAD.

  • The abstract states PM2.5 may induce CAD through CRP, ALT and HB, and that the mediation effect sizes were significant.
  • CRP, ALT and HB were described as the main mediating factors between PM2.5 and CAD.
  • Correlation and mediation analyses were used to explore underlying mechanisms.
Results

The model results remained stable in sensitivity analysis.

  • Sensitivity analysis was conducted to verify model stability, and the authors report the model results remained stable.
Conclusions

The authors conclude PM2.5 is a potential risk factor for CAD in children with Kawasaki disease.

  • Authors also state that PM2.5 may lead to an increased incidence of Kawasaki disease in children, and that inhalation may cause CAD through a population-based cohort study.
  • The process may be mediated by increased C-reactive protein.

What This Means

This study looked at whether air pollution, specifically fine particles called PM2.5, is linked to damage to the heart's coronary arteries in children with Kawasaki disease, a serious inflammatory illness of childhood. Researchers examined 847 children from 2017 to 2021 in China, comparing their exposure to PM2.5 around the time of illness with exposure at other times, and measured coronary artery dilatation using a standard score (Z value). They found that higher PM2.5 exposure was linked to a greater risk of coronary artery dilatation, particularly 2 to 4 days after exposure. The strongest link was at 3 days, where risk was about 11% higher (RR 1.11, 95% CI 1.02 to 1.21). Statistical analyses suggested that inflammation and related blood markers (C-reactive protein, alanine aminotransferase, and hemoglobin) may help explain how PM2.5 could affect the coronary arteries. This research suggests that air pollution may be a risk factor for heart complications in children with Kawasaki disease. The study shows an association rather than proof of cause, and the mediation findings point to possible mechanisms that would need further confirmation. The results remained stable in sensitivity checks.

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Citation

Huang Z, Huang S, Lin Y, Guo W, Li Y, Fang J, et al.. (2026). Association between PM2.5 and coronary artery dilatation with Kawasaki disease in China.. European journal of pediatrics. https://doi.org/10.1007/s00431-026-07527-9