Patients with autism spectrum disorder (ASD) may be at an increased risk for cardiometabolic diseases. The results of this systemic review and meta-analysis were published in JAMA Pediatrics.
The investigators from Texas Tech University searched publication databases from inception through July 2022 for studies evaluating risk for diabetes mellitus, hypertension, dyslipidemia, and atherosclerotic macrovascular disease in the setting of ASD. A total of 34 studies were included in this review.
The pooled study population comprised 276,173 cases with ASD and 7,733,306 controls. The ASD and control cohorts were aged mean 22.8 and 31.2 years, respectively, and the ASD cohort was dominated by women and girls in a 3:1 ratio and the controls comprised 47% women and girls.
Compared with controls, ASD was associated with a 57.3% increased risk for diabetes (relative risk [RR], 1.57; 95% CI, 1.23-2.01; P <.001). Stratified by type, ASD was associated with an increased risk for both type 1 (RR, 1.64; 95% CI, 1.06-2.54; P =.03) and type 2 (RR, 2.47; 95% CI, 1.30-4.70; P =.006) diabetes compared with controls.
In an exploratory meta-regression analysis, risk for diabetes was related with ASD among Arabic, Asian, Black, Hispanic, Jewish, Multiracial, and unspecified ethnicities compared with White individuals (β, 1.32; P =.02), among children compared with adults (β, 0.75; P =.008), and among individuals living outside the United States compared with those living in the US (β, 0.56; P =.02).
Similarly, ASD was associated with a 69.4% increased risk for dyslipidemia (RR, 1.69; 95% CI, 1.20-2.40; P =.003). Stratified by individual lipids, ASD associated with elevated triglycerides (mean difference [MD], 25.83; 95% CI, 8.42-43.24 mg/dL; P =.004) and low high-density lipoprotein cholesterol (MD, -9.35; 95% CI, -13.42 to -5.28 mg/dL; P <.001) levels.
Macrovascular disease overall was not related with ASD (RR, 1.09; 95% CI, 0.75-1.60; P =.65). However, stratified by specific disease, ASD was related with an increased risk for heart disease (RR, 1.46; 95% CI, 1.42-1.50; P <.001). In a leave-one-out sensitivity analysis, stroke risk became significantly association with ASD (RR, 1.51; 95% CI, 1.28; 1.78; P <.001).
There was no evidence to support a relationship between ASD and risk for hypertension in general (RR, 1.22; 95% CI, 0.98-1.52; P =.08). However, some evidence suggested that age was a negative moderator of the relationship (β, -0.011; P =.02) and that only among children, risk for hypertension was associated with ASD (RR, 2.54; 95% CI, 1.56-4.12; P <.001).
The major limitation of this analysis was the differing outcomes among studies, especially for diabetes and cardiovascular disease.
The study authors concluded, “Results of this systematic review and meta-analysis suggest that autism seems to be associated with an increased risk of diabetes mellitus, dyslipidemia, and atherosclerotic heart disease. Children with autism seem to possess a higher risk of developing diabetes mellitus and hypertension compared with children without autism. 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.”
Dhanasekara CS, Ancona D, Cortes L, et al. Association between autism spectrum disorders and cardiometabolic diseases: a systematic review and meta-analysis. JAMA Pediatr. 2023;e225629. doi:10.1001/jamapediatrics.2022.5629