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Association Between Autism Spectrum Disorders and Cardiometabolic Diseases: A Systematic Review and Meta-analysis
Chathurika S Dhanasekara1,2, Dominic Ancona1, Leticia Cortes1
1Department of Laboratory Science and Primary Care, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock.
Insights
Individuals with autism have a significantly higher risk of developing diabetes, dyslipidemia, and heart disease. This highlights the need for vigilant monitoring of cardiometabolic health in this population.
Area of Science:
- Public Health
- Neurodevelopmental Disorders
- Cardiology
Background:
- The increased risk of obesity in individuals with autism is established.
- Evidence linking autism, cardiometabolic disorders, and obesity is inconclusive.
- Understanding these associations is crucial for preventative healthcare strategies.
Purpose of the Study:
- To systematically review and meta-analyze the association between autism spectrum disorders (ASD) and cardiometabolic diseases.
- To quantify the risks of specific cardiometabolic conditions in individuals with ASD.
Main Methods:
- A comprehensive search of multiple databases (PubMed, Scopus, Web of Science, etc.) was conducted up to July 31, 2022.
- Included observational or baseline data from studies comparing individuals with and without autism regarding cardiometabolic risk factors.
- Meta-analyses were performed using DerSimonian-Laird random-effects models.
Main Results:
- Autism was associated with increased risks of overall diabetes (RR, 1.57), type 1 diabetes (RR, 1.64), and type 2 diabetes (RR, 2.47).
- Increased risks of dyslipidemia (RR, 1.69) and heart disease (RR, 1.46) were observed in individuals with autism.
- No significantly increased risk of hypertension or stroke was found, though children with autism showed higher risks than adults.
Conclusions:
- Individuals with autism spectrum disorder face elevated risks for several cardiometabolic diseases, particularly diabetes and dyslipidemia.
- Clinical monitoring for cardiometabolic disease signs and complications in individuals with autism is strongly recommended.
- Further research may be needed to address heterogeneity and clarify risks for hypertension and stroke.
Importance:
Although the increased risk of obesity among individuals with autism has been well established, evidence on the association between autism, cardiometabolic disorders, and obesity remains inconclusive.
Objective:
To examine the association between autism spectrum disorders and cardiometabolic diseases in a systematic review and meta-analysis.
Data Sources:
PubMed, Scopus, Web of Science, ProQuest, Embase, and Ovid databases were searched from inception through July 31, 2022, without restrictions on date of publication or language.
Study Selection:
Observational or baseline data of interventional studies reporting the prevalence of cardiometabolic risk factors (ie, diabetes, hypertension, dyslipidemia, atherosclerotic macrovascular disease) among children and/or adults with autism and matched with participants without autism were included.
Data Extraction And Synthesis:
Screening, data extraction, and quality assessment were performed independently by at least 2 researchers. DerSimonian-Laird random-effects meta-analyses were performed using the meta package in R.
Main Outcomes And Measures:
Relative risks (RRs) of diabetes, hypertension, dyslipidemia, and atherosclerotic macrovascular disease among individuals with autism were the primary outcomes. Secondary outcomes included the RR of type 1 and type 2 diabetes, heart disease, stroke, and peripheral vascular disease.
Results:
A total of 34 studies were evaluated and included 276 173 participants with autism and 7 733 306 participants without autism (mean [range] age, 31.2 [3.8-72.8] years; pooled proportion [range] of female individuals, 47% [0-66%]). Autism was associated with greater risks of developing diabetes overall (RR, 1.57; 95% CI, 1.23-2.01; 20 studies), 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). Autism was also associated with increased risks of dyslipidemia (RR, 1.69; 95% CI, 1.20-2.40; 7 studies) and heart disease (RR, 1.46; 95% CI, 1.42-1.50; 3 studies). Yet, there was no significantly associated increased risk of hypertension and stroke with autism (RR, 1.22; 95% CI, 0.98-1.52; 12 studies; and RR, 1.19; 95% CI, 0.63-2.24; 4 studies, respectively). Meta-regression analyses revealed that children with autism were at a greater associated risk of developing diabetes and hypertension compared with adults. High between-study heterogeneity was a concern for several meta-analyses.
Conclusions And Relevance:
Results suggest that the associated increased risk of cardiometabolic diseases should prompt clinicians to vigilantly monitor individuals with autism for potential contributors, signs of cardiometabolic disease, and their complications.
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