The Association between Antipsychotic Use and Cardiovascular Disease Risk Factors in Autistic Adults

Background and Purpose: Cardiovascular disease (CVD) limits quality of life and is the leading cause of early mortality in the general population. Although approximately 40% of American adults are affected by CVD and its primary risk factors (e.g., high blood pressure, high cholesterol, diabetes, and overweight or obesity), a growing body of evidence from population-based samples suggests that among autistic adults this risk may be even higher. Mechanisms underlying the high prevalence of CVD risk factors in autistic people are likely multifactorial and may include known correlates of CVD risk factors in other populations, including high levels of perceived stress, poor sleep quality, and antipsychotic medication use. As such, we aimed to: (1) describe self-reported CVD risk factors in a large sample of autistic adults without intellectual disability; and (2) test the association between CVD risk factors and antipsychotic medication use, sleep quality, and perceived stress.

Methods: 610 autistic adults without intellectual disability aged 18+ were recruited through the Simons Foundation Powering Autism Research (SPAR) Research Match as part of a larger study of adult outcomes. Autistic participants were mostly female (N=387; 63.4%) and white (N=505; 82.9%), and they ranged in age from 18-78 years (Mean=39.87, SD=13.61). We summarized prevalence of CVD risk factors (high blood pressure, high cholesterol, diabetes, and overweight or obesity, operationalized here as BMI³25) using descriptive statistics. Multiple linear regression models examined the association between our key independent variables (perceived stress, global sleep quality, and antipsychotic medication use) and number of CVD risk factors, controlling for demographic variables (age, sex assigned at birth, race). Four separate exploratory logistic regression models tested the association between independent variables included in Model 1 and the individual CVD risk factors (hypertension, high blood pressure, diabetes, and BMI³25; each individual CVD risk factor was a dependent variable in one of four models), controlling for the demographic characteristics.

Results: Overall, 73.6% (N=449) of autistic adults in our sample had BMI³25 (, while 43.4% (N=265) had high cholesterol, 37.9% (N=231) had high blood pressure, and 9.7% (N=59) had diabetes. Only about a quarter of autistic adults (25.9%; N=158) had no CVD risk factors. A minority of autistic adults in our sample (15.2%; N=93) reported taking one or more antipsychotic medications. Older age, female sex assigned at birth, and poorer sleep quality were associated with a higher number of CVD risk factors. Exploratory findings indicates that sing antipsychotic medications was associated with an increased likelihood of having diabetes and that poorer sleep quality was associated with an increased likelihood of both having diabetes and having a BMI>25.

Conclusions and Implications: Self-reported CVD risk factors are highly prevalent among autistic adults. Poorer sleep quality was associated with both an increased number of CVD risk factors and with an increased likelihood of having a BMI>25 and diabetes, while using antipsychotic medications was associated with an increased likelihood of diabetes. Improving sleep quality and reducing antipsychotic medication use among autistic adults both have the potential to improve the quality of autistic adults’ health and lives.