Cardiometabolic conditions in people with autism spectrum disorder: a nationwide prospective cohort study from the Netherlands

Little is known about the association between autism spectrum disorder (ASD) and cardiometabolic conditions across the lifespan. We conducted the largest cohort study, using Dutch register data of 8,690,286 individuals aged 12–65 years. These individuals were followed up from January 1, 2014 to their first incidence of cardiometabolic conditions, emigration, death, or December 31, 2020. Cox proportional-hazards models indicated ASD was associated with higher risks of cardiometabolic conditions (hazard ratio (HR): 1.20, 95% confidence interval (CI): 1.18–1.23, specifically hypertension (HR: 1.16; CI: 1.14–1.19), dyslipidemia (HR: 1.17; CI: 1.12–1.23), diabetes (HR: 1.22; CI: 1.14–1.30), stroke (HR: 1.23; CI: 1.14–1.34), and heart failure (HR: 1.28; CI: 1.07–1.53). Sex-stratified findings were similar. Associations were observed in adolescent, young (18–30 years), and middle-aged (31–40 years), but not older individuals, indicating earlier onset in autistic compared to non-autistic individuals. Our results underscore the need of monitoring and treatment of cardiometabolic conditions among individuals with ASD.