Children, Adults with Autism Face Heightened Risk of Cardiometabolic Illnesses

Chanaka N. Kahathuduwa, MD, MPhil, PhD

Results of a study conducted by investigators at Texas Tech University underlines the need for reform in health screenings and a more holistic approach to care for people with autism.

Results of the systematic review and meta-analysis, which included nearly 3 dozen published articles reporting cardiometabolic risk factors among people with autism spectrum disorder and matched controls, indicate people with autism had a greater relative risk of developing a slew of cardiometabolic disorders compared to their counterparts without autism, including both type 1 and type 2 diabetes, dyslipidemia, and cardiovascular disease.

“To our knowledge, this was the first comprehensive systematic review and meta-analysis exploring the autism associated risks of diabetes mellitus, hypertension, dyslipidemia, and macrovascular disease,” wrote investigators. “Based on our results, individuals with autism seem to be at a greater associated risk of developing DM by 57.3%, type 1 diabetes mellitus by 64.1%, type 2 diabetes mellitus by 146.7%, dyslipidemia by 69.4%, and atherosclerotic heart disease by 45.9%.”

Citing previous data outlining the potential for elevated cardiometabolic risk, a team of investigators led by Chanaka Kahathuduwa, MD, MPhil, PhD, of the Department of neurology at Texas Tech University, designed the current study as a systematic review and meta-analysis of observational or baseline data of intervention studies reporting prevalence of cardiometabolic risk factors among children or adults with autism and matched participants without autism. With this in mind, the investigators performed a search of the PubMed, Scopus, Web of Science, ProQuest, Emboss, and Ovid databases from inception through July 21, 2022 without restrictions on date of publication or language.

From their search, investigators identified 34 studies encompassing more than 8 million individuals for inclusion in the systematic review and meta-analysis. The overall study cohort included 276,173 participants with autism and 7,733,306 participants without autism. The cohort of participants without autism had a mean age of 31.2 (range, 3.8-72.8) years and the cohort of participants with autism had a mean age of 22.8 (range, 3.8-72.8) years. The pooled cohort was 47% were female.

The primary outcome of interest for the study was the RR of diabetes, hypertension, dyslipidemia, and atherosclerotic macrovascular disease among people with autism. Secondary outcomes of interest included the RR of type 1 and type 2 diabetes, cardiovascular disease, stroke, and peripheral artery disease. Of the 34 studies identified for inclusion, 22 reported statistics allowing for computation of relative risk (RR) of cardiometabolic risk factors and the other 12 reported laboratory measurements of interest.

Upon analysis, results indicated a diagnosis of autism was associated with greater risks of developing diabetes overall (RR, 1.57 [95% CI, 1.23-2.01]; 20 studies) as well as for type 1 diabetes (RR, 1.64 [95% CI, 1.06-2.54]; 6 studies) and type 2 diabetes (RR, 2.47 [95% CI, 1.30-4.70]; 3 studies) as individual outcomes of interest. Further analysis indicated a diagnosis of autism was associated with a greater risk of dyslipidemia (RR, 1.69. [95% CI, 1.20-2.40]; 7 studies) and cardiovascular disease (RR, 1.46 [95% CI, 1.42-1.50]; 3 studies).

However, investigators pointed out no statistically significant association of increased risk was observed for hypertension (RR, 1.22 [95% CI, 0.98-1.52]; 12 studies) and stroke (RR, 1.19 [95% CI, 0.63-2.24]; 4 studies) among people with autism. In meta-regression analyses, results indicated children with a diagnosis of autism were at a greater is of developing hypertension and diabetes than adults, but investigators called attention to a concerningly high level of between-study heterogeneity for several meta-analyses.

In a related editorial, Elizabeth Weir, PhD, of the Autism Research Centre in the Department of Psychiatry at the University of Cambridge, underlined the importance of the study’s findings on emphasizing the need for reform in management given the rising rates of autism spectrum disorder and the already shortened life expectancy for these patients.

“The results from this systematic review and meta-analysis require clinicians and researchers alike to radically rethink the health care provision that is currently provided to autistic people,” Weir wrote. “More support for both mental and physical health care across the life span should be offered and new research on how to improve outcomes is critical.”

This study, “Association Between Autism Spectrum Disorders and Cardiometabolic Diseases,” was published in JAMA Pediatrics.