People with autism are more likely to face diabetes, high cholesterol, and heart disease than those without the neurologic condition, according to a new study published this week in JAMA Pediatrics. Researchers also found that children with autism are especially likely to develop diabetes compared with their peers, and are at greater risk of hypertension, too.
While the link between autism and risk for obesity and gastrointestinal ailments is well-established, the new findings suggest that clinicians who care for these patients — particularly children — should focus on cardiometabolic health more broadly.
"Clinicians who are treating kids with autism need to pay more attention to this," said Chanaka N. Kahathuduwa, MD, MPhil, PhD, of the Department of Neurology at Texas Tech University Health Sciences Center, in Lubbock, and a coauthor of the new study.
A pediatrician may prescribe an atypical antipsychotic medication such as risperidone to regulate the behavior of an autistic child, Kahathuduwa said, which may increase their cholesterol levels. Although this or similar drugs may be necessary in some cases, Kahathuduwa advised that clinicians explore other treatment options first.
Mining Data From Previously Published Studies
For the new analysis, Kahathuduwa and his colleagues pooled the results of 34 previously published studies, which included medical records of more than 276,000 people with autism and close to 8 million people without the condition.
Study participants were an average age of 31 years, and 47% were female. Some studies reported age ranges that enabled the researchers to differentiate between children and adults.
People with autism were 64% more likely to develop type 1 diabetes, 146% more likely to experience type 2 diabetes, and 46% more likely to have heart disease, overall, the study found. Children with autism were almost twice as likely as their peers to develop diabetes (184%) and high blood pressure (154%).
The study found associations, not causation, and does not include detailed data about medication prescribing patterns. While it would be ideal to understand why autism is linked to cardiometabolic risk, to address the link most effectively, Kahathuduwa said the causes likely are multifactorial. Medication history and genetics each play a role in a way that is hard to untangle. Even so, Kahathuduwa said he hoped the findings prompt clinicians to reevaluate how they treat their patients with autism.
"This may be an eye opener," he said.
An editorial accompanying the study noted that people with autism may die up to 30 years earlier than people without autism, due in part to the physical health problems surfaced in the new research. They also are more likely than others to attempt suicide.
Elizabeth M. Weir, PhD, of the Autism Research Centre at the University of Cambridge in the United Kingdom and author of the editorial, argued that current models of health delivery often fail people with autism by not asking them if they would like accommodations.
Weir told Medscape Medical News that clinicians should start by asking what would improve their quality of care. Such steps might require healthcare settings to change fluorescent lights to warm white LEDs to adjust for hypersensitive patients or to provide written or chat-based means of communication. At minimum, patients with autism should be allowed to bring an advocate to appointments, something not always offered or permitted.
"Clinicians should start by asking their autistic patients what would improve their own quality of care," Weir said. "Autistic people sit along a wide spectrum of strengths and challenges across several different domains; as such, each autistic person will likely need different types of support and adjustments regarding their healthcare."
"I diagnose autism pretty much every day and I know families get so overwhelmed with all the recommendations that we give," said Sonia Monteiro, MD, a developmental and behavioral pediatrician at Texas Children’s Hospital, in Houston. Still, Monteiro said clinicians should help parents of children with autism address the potential long-term cardiovascular risks — but to do so by layering in the information rather than merely adding more bullet points to an already long presentation.
"We know this information now, but finding a way to share that with families without overwhelming them even more, I think is challenging," Monteiro said. "But it’s not something we can ignore."
This story was updated on February 6, 2023, to include additional information from Weir.
Kahathuduwa, Weir, and Monteiro report no relevant financial relationships.
JAMA Pediatrics. Published January 30, 2023. Abstract.
Marcus A. Banks, MA, is a journalist based in New York City who covers health news with a focus on new cancer research. His work appears in Medscape, Cancer Today, The Scientist, Gastroenterology & Endoscopy News, Slate, TCTMD, and Spectrum.
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Cite this: Autism Linked to Poor Cardiovascular Health - Medscape - Jan 31, 2023.