Cardiometabolic Risk With Autism: Vigilance Urged

People with autism had an elevated risk of cardiometabolic conditions across several dozen studies, researchers confirmed in a meta-analysis.

Among children and adults in the analyzed studies, autism was associated with greater likelihood of concomitant:

• Diabetes overall (RR 1.57, 95% CI 1.23-2.01)
• Type 1 diabetes (RR 1.64, 95% CI 1.06-2.54)
• Type 2 diabetes (RR 2.47, 95% CI 1.30-4.70)
• Dyslipidemia (RR 1.69, 95% CI 1.20-2.40)
• Heart disease (RR 1.46, 95% CI 1.42-1.50)

Yet, there was no significantly associated increased risk of hypertension and stroke with autism across all age groups, according to investigators led by Chanaka Kahathuduwa, MD, MPhil, PhD, of Texas Tech University Health Sciences Center in Lubbock.

Only children with autism appeared to be at higher risk of diabetes and hypertension in the meta-analysis published in JAMA Pediatrics.

“Because developing cardiometabolic disease at an early age raises morbidity and health concerns, the need for health care, and mortality, clinicians should vigilantly monitor individuals with autism for early signs of cardiometabolic disease and their complications,” the authors urged.

Autism is estimated to affect one in 44 U.S. children, according to the CDC, and reported cases have been rising steadily over the last 20 years. Autism is associated with multiple medical, neurologic, and psychiatric comorbidities — and death at younger age.

“Clinicians need to think carefully about how to intervene with health education to empower autistic people, while also recognizing the real challenges that trauma and mental health conditions can pose for maintaining healthy lifestyle behaviors,” commented Elizabeth Weir, PhD, of the University of Cambridge, England, in an accompanying editorial.

“Providing appropriate screening for conditions and support for healthy lifestyle habits during childhood is integral; early intervention in these areas is essential for ensuring that autistic people are able to live healthy, long, and fulfilling lives,” the editorialist emphasized.

For their meta-analysis, Kahathuduwa and colleagues pooled 34 studies with a total of 276,173 individuals with autism and over 7 million peers without autism (mean age 31.2 years, 47% women).

“While this study provides important and clinically relevant results, its quality is inherently limited by the quality of the studies that it meta-analyzed,” Weir warned. “This is highlighted by the fact that the present study could not consider the influence of intellectual ability, body mass index, psychotropic medication use, or increasing age on these outcomes — expressly because the original 34 studies did not consistently provide these data.”

She suggested future research focus on addressing whether these factors serve to mediate or moderate risk of chronic disease in a different way for autistic people than for others. Additionally, there could be more work done on evidence-based interventions to improve healthcare access for autistic people, she noted.

One study recently found that disproportionately few autistic people reported being able to describe how their symptoms and pain feels, to understand what their clinician means when discussing their health, to know what is expected of them when they go to see their clinical appointments, and other fundamental aspects of healthcare encounters.

“Autistic people have also stated that taking extra time in appointments, providing guidance on how to prepare for visits and navigate the health care system, ensuring continuity of care, and offering alternative forms of communication (e.g., written or chat-based) would help to improve their health care quality,” according to Weir.