Autism and the Heart: Why Cardiovascular Risk Matters

By Andres Griborio, M.D.,C.M., FRCPC

Autism is a common neurodevelopmental condition that affects communication, social interaction, and behaviour across the lifespan. In Canada, about 2% of children are diagnosed with autism, and most autistic people are now adults. All clinicians will have autistic patients. Emerging evidence links autism to substantially higher rates of cardiovascular and metabolic disease and to premature cardiovascular death.

A meta‑analysis of 34 cohort studies (over 276,000 autistic individuals and 7.7 million controls) found that autistic people are about 1.5 times more likely to develop atherosclerotic heart disease, 1.6 times more likely to develop diabetes (both type 1 and type 2), and 1.7 times more likely to have dyslipidemia than non‑autistic peers. Autistic children have roughly 2.8‑fold higher risk of diabetes and at least 2.5‑fold higher risk of hypertension. Overall, autistic people have a 2–10‑fold higher risk of premature mortality and die, on average, 16–39 years earlier than non‑autistic individuals, with circulatory diseases accounting for about one quarter of deaths, most commonly from ischemic heart disease.

A Canadian Journal of Cardiology review describes a multifactorial model involving biological, behavioural, and health‑system factors. Autism and cardiometabolic disease may share genetic pathways and are linked to higher rates of autoimmune disease, while perinatal factors may add long‑term risk. Behaviourally, autistic adults tend to smoke and drink less but are less likely to meet recommendations for physical activity, diet, and sleep because of food selectivity, motor and gait challenges, sensory sensitivities, and executive function difficulties. Some patients with autism take psychotropic medications for conditions that commonly co-occur with autism, compounding cardiometabolic risks, alongside a “dual risk” of obesity and underweight, which is not fully explained by lifestyle. Health‑system and communication barriers (like difficulty describing symptoms or pain, understanding clinicians, and navigating busy, sensory‑overloading environments) can delay recognition and treatment of risk factors and acute presentations such as chest pain.

For Manitoba ACS Network clinicians, autism should function as a cardiometabolic risk amplifier when assessing and managing cardiovascular risk. Practical steps include:

• Flagging autism as a risk‑enhancing factor and using it as a prompt for proactive cardiometabolic screening and prevention.

• Considering earlier and more frequent screening for hypertension, dyslipidemia, and metabolic syndrome, including in young adults with autism, and monitoring cardiometabolic parameters when starting or escalating psychotropic medications.

• Adapting counselling and visits by focusing on a small number of concrete, realistic lifestyle goals, providing written summaries or checklists, asking about sensory triggers and communication preferences, and, when feasible, booking longer visits and involving a trusted supporter.

• Maintaining a lower threshold for ECG and troponin testing when autistic patients present with concerning but non‑specific symptoms or a clear change from baseline, recognizing that symptoms may be under‑reported or described atypically.

Autistic people face substantially higher cardiometabolic risk and premature cardiovascular death, but many drivers of this risk are modifiable within current ACS and cardiology practice.

References

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