A retrospective matched cohort study of 23,612 autistic adults drawn from UK primary and secondary care records (matched 1:5 to 118,060 non-autistic controls) found autistic people carry a 19% higher risk of major ischaemic events — encompassing myocardial infarction, angina, ischaemic stroke, and transient ischaemic attacks — in minimally adjusted models. The signal was strongest and persisted after full covariate adjustment in autistic women, who showed a 71% elevated hazard (aHR 1.71; 95% CI: 1.10–2.67). Cardiometabolic risk factors including severe mental illness, dyslipidaemia, and obesity were all significantly more prevalent in the autistic group.
This finding matters because it shifts autism cardiovascular risk from a background concern to a quantified clinical priority. Prior literature has documented higher cardiometabolic burden in autistic populations, but direct ischaemic event data were absent. The female-specific residual risk is particularly striking: even after stripping out known mediators, something unmeasured — possibly chronic stress physiology, autonomic dysregulation, diagnostic overshadowing, or sex-specific inflammatory pathways — drives excess risk in autistic women. Clinicians may be systematically under-screening this group.
Limitations are real: the observational design cannot establish causation, electronic health record coding of autism is incomplete, and unmeasured confounders remain. The 30-year study window also spans major changes in both autism diagnosis rates and cardiovascular care. Crucially, this is a preprint posted on medRxiv and has not yet been peer-reviewed — findings should be interpreted cautiously until independent scrutiny is complete. If replicated, this is a clinically actionable, underappreciated public health gap.
