Heart disease is often thought of as a problem that appears later in life, but a growing body of research shows that some groups face cardiovascular risks much earlier. One of those groups is people on the autism spectrum.
A large nationwide study from the Netherlands has found that adolescents and adults with autism are more likely to develop cardiometabolic conditions such as hypertension, dyslipidemia, diabetes, stroke and heart failure, and that these problems tend to appear at younger ages than in people without autism.
Autism and Cardiometabolic Risk: What the Study Found
Researchers followed more than 8.6 million people aged 12 to 65 years using Dutch health registers between 2014 and 2020. They compared those with a diagnosis of autism to those without and looked for the first time they were diagnosed with a cardiometabolic condition.
After accounting for key factors, they found that autistic people had:
- About a 20% higher overall risk of developing any cardiometabolic condition
- Higher risk of hypertension (high blood pressure)
- Higher risk of dyslipidemia (unhealthy cholesterol or triglyceride levels)
- Higher risk of type 2 diabetes
- Higher risk of stroke
- Higher risk of heart failure
These patterns were seen in both autistic males and autistic females. The strongest signal was not only the increased risk, but the earlier onset. Adolescents, young adults and middle-aged adults with autism had higher rates of new cardiometabolic diagnoses than their non-autistic peers, while older adults showed less difference. This suggests that autism is linked with a shift toward earlier cardiovascular and metabolic disease.
Why Might Autism Be Linked With Heart and Metabolic Conditions?
The study itself was not designed to prove why these links exist, but it builds on a wider body of research pointing to several possible explanations. For many readers, these are also practical starting points for thinking about how to prevent heart disease and protect long-term health.
1. Lifestyle and Everyday Environment
Many autistic people face unique challenges that can influence diet, movement and sleep, all of which are central to heart health.
- Selective eating and sensory sensitivities. Texture, taste and smell can strongly shape food choices. This sometimes leads to diets that are low in fiber, fruits and vegetables and higher in processed foods, sugar or salt, which can increase the risk of hypertension, dyslipidemia and diabetes.
- Lower physical activity. Difficulties with team sports, crowded environments or sudden changes can make traditional exercise settings hard to tolerate. This can lead to more sedentary behavior unless accessible alternatives, such as cardiovascular exercises at home, are built into daily routines.
- Sleep problems. Insomnia and irregular sleep patterns are common in autism and are linked to higher blood pressure, weight gain and insulin resistance.
2. Mental Health and Stress Load
Anxiety, depression and chronic stress are more common in autistic adults and can raise levels of stress hormones that affect blood pressure, blood sugar and inflammation. Over time, this can contribute to cardiometabolic disease.
Stress related to social demands, sensory overload and stigma can be persistent, so building supportive environments and access to mental health care is not just about emotional wellbeing. It is also part of a strategy to prevent cardiovascular disease.
3. Medications and Medical Care
Some psychotropic medications, particularly certain antipsychotics and mood stabilizers, can increase appetite, promote weight gain, or adversely affect cholesterol and glucose regulation. The Dutch cohort study did not pin risk solely on medication, but the broader literature suggests it can be one piece of the puzzle.
At the same time, autistic people often face barriers to healthcare, including difficulties with communication, sensory overload in clinics and misinterpretation of symptoms. These barriers can delay detection of hypertension, dyslipidemia or early signs of a heart attack, which makes routine, autism-informed screening especially important.
4. Biological and Genetic Factors
Research also points to possible shared genetic and biological pathways between autism and cardiometabolic diseases. Differences in metabolism, inflammation, hormone regulation, the gut microbiome and brain energy use have all been explored, although no single explanation has been confirmed.
What the new Dutch study adds is strong epidemiological evidence that, whatever the cause, the link is real at a population level and affects both sexes from adolescence onward.
Recognizing Early Signs of Heart and Metabolic Problems
Because cardiometabolic conditions appear earlier in autistic individuals, understanding early warning signs and screening options is vital for families, clinicians and autistic adults themselves.
Key Early Signs of a Heart Attack
Heart attacks can present atypically, especially in women, older adults and people with other medical or neurodevelopmental conditions. Classic and less typical early signs of a heart attack include:
- Pressure, tightness or pain in the chest that lasts more than a few minutes or comes and goes
- Pain or discomfort spreading to one or both arms, the back, neck, jaw or stomach
- Shortness of breath with or without chest discomfort
- Cold sweat, nausea or lightheadedness
- Unusual fatigue, especially in women
If any of these occur suddenly, emergency medical care is needed right away. It is helpful to prepare simple, direct language or communication aids so an autistic person can describe symptoms clearly in an emergency.
Early Clues of Hypertension, Diabetes and Dyslipidemia
Many cardiometabolic issues have few or no obvious symptoms in early stages. This is why preventive care matters so much.
- Hypertension (high blood pressure) often has no symptoms but can cause headaches, nosebleeds or vision changes in some people.
- Diabetes may cause increased thirst, frequent urination, unexplained weight loss or fatigue.
- Dyslipidemia (unhealthy cholesterol or triglyceride levels) rarely causes symptoms until it contributes to other problems like heart disease or stroke.
Regular check-ups that include blood pressure, blood tests for glucose and lipids and weight or waist measurements are crucial, especially for autistic adolescents and adults whose risk may be higher and earlier than previously thought.
How to Prevent Heart Disease in People With Autism
The Dutch study strongly supports one simple but powerful message: autism should be a prompt for proactive heart and metabolic health, not a reason to delay or overlook it. The principles of how to prevent heart disease remain the same, but they need to be adapted to individual needs, preferences and sensory profiles.
1. Build Accessible Cardiovascular Exercises at Home
Physical activity is one of the most effective ways to protect heart health and improve blood pressure, lipids and insulin sensitivity. For many autistic people, home-based routines work better than gyms or groups.
Practical cardiovascular exercises at home include:
- Walking or marching in place while listening to favorite music or using a step counter for structure.
- Low-impact aerobics using simple video routines with predictable patterns and minimal verbal instruction.
- Stationary cycling or pedal exercisers that can be used while watching a familiar show.
- Mini circuits such as short bursts of jumping jacks, step-ups on a low step, or brisk stair climbing with rest in between.
To be effective, aim for at least 150 minutes per week of moderate-intensity activity, broken into short, manageable blocks that feel achievable and predictable. Visual schedules, timers and rewards can make routines more sustainable.
2. Focus on the Best Foods for Heart Health, With Sensory Flexibility
Nourishing the heart does not require a perfect diet. It means repeatedly choosing patterns of eating that support healthy blood pressure, cholesterol and blood sugar, while still respecting sensory preferences and routines.
Some of the best foods for heart health are:
- Colorful fruits and vegetables, fresh, frozen or canned with minimal added salt or sugar. Smooth textures, purees, or simple roasted vegetables can be easier for some sensory profiles.
- Whole grains such as oats, brown rice, wholegrain bread or pasta. If textures are difficult, start with finely milled wholegrain products or mix wholegrain with familiar refined versions.
- Healthy fats from nuts, seeds, olive oil, avocado and oily fish like salmon or mackerel, which support heart and brain health.
- Lean proteins such as beans, lentils, eggs, poultry and tofu, which help with satiety and blood sugar balance.
Small, gradual shifts tend to work better than sweeping changes. For example, switching one sugary drink per day to water, or adding a single fruit serving at breakfast, can be a realistic start. Registered dietitians who understand autism can help tailor plans that honor preferred foods and routines.
3. Prioritize Sleep and Stress Regulation
Improving sleep and managing stress are both protective against cardiometabolic disease. Helpful strategies include:
- Consistent bed and wake times, with a predictable pre-sleep routine
- Reducing stimulating screens close to bedtime
- Creating a low-noise, low-light sleeping environment with weighted blankets or familiar objects if soothing
- Using visual supports or social stories to explain bedtime expectations
- Access to psychological therapies or coaching that respect autistic communication and processing styles
4. Make Medical Monitoring Routine and Autism-Informed
Because cardiometabolic issues may appear earlier, clinicians caring for autistic adolescents and adults should consider:
- Starting blood pressure, lipid and glucose checks in the teen years, especially if there is a family history of cardiovascular disease, obesity or diabetes
- Reviewing medications regularly for cardiometabolic side effects
- Providing clear explanations of procedures, with visual aids or written summaries
- Scheduling appointments at quieter times of day to reduce sensory overload
For families and autistic adults, preparing a simple health passport that lists diagnoses, medications, communication preferences and sensory needs can make visits more efficient and less stressful, encouraging regular care rather than emergency-only visits.
What This Research Means for Cardiovascular Disease Treatments
The Dutch study does not change the basic science of cardiovascular disease treatments, but it does change our understanding of who needs them and when. Autistic people may require:
- Earlier lifestyle support focused on practical, sensory-aware approaches to movement and nutrition.
- Timely use of medications for hypertension, diabetes or dyslipidemia, with careful monitoring of side effects and interactions.
- Rehabilitation and follow-up after stroke or heart failure that accommodates communication styles, fatigue patterns and sensory needs.
In other words, standard cardiovascular disease treatments still apply, but they should be delivered in ways that are accessible and acceptable to autistic individuals so that they can fully benefit from them.
Supporting Heart Health Across the Autistic Lifespan
The message from this nationwide cohort study is clear. Autistic people are at increased risk of cardiometabolic conditions such as hypertension, dyslipidemia, diabetes, stroke and heart failure, and these conditions tend to appear earlier in life. This makes prevention and early detection especially important.
Practical steps such as introducing cardiovascular exercises at home, gradually shifting toward the best foods for heart health, prioritizing restorative sleep and stress regulation, and committing to regular, autism-informed medical check-ups can together lower risk and support a longer, healthier life.
For families, healthcare providers and autistic adults, seeing heart and metabolic health as part of routine autism care is not optional. It is a central part of protecting wellbeing across the lifespan.