Parity, breastfeeding and risk of coronary heart disease: A pan-European case–cohort study
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OBJECTIVE: There is uncertainty about the direction and magnitude of the associations between parity, breastfeeding and the risk of coronary heart disease (CHD). We examined the separate and combined associations of parity and breastfeeding practices with the incidence of CHD later in life among women in a large, pan-European cohort study. METHODS: Data were used from European Prospective Investigation into Cancer and Nutrition (EPIC)-CVD, a case-cohort study nested within the EPIC prospective study of 520,000 participants from 10 countries. Information on reproductive history was available for 14,917 women, including 5138 incident cases of CHD. Using Prentice-weighted Cox regression separately for each country followed by a random-effects meta-analysis, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for CHD, after adjustment for age, study centre and several socioeconomic and biological risk factors. RESULTS: Compared with nulliparous women, the adjusted HR was 1.19 (95% CI: 1.01-1.41) among parous women; HRs were higher among women with more children (e.g., adjusted HR: 1.95 (95% CI: 1.19-3.20) for women with five or more children). Compared with women who did not breastfeed, the adjusted HR was 0.71 (95% CI: 0.52-0.98) among women who breastfed. For childbearing women who never breastfed, the adjusted HR was 1.58 (95% CI: 1.09-2.30) compared with nulliparous women, whereas for childbearing women who breastfed, the adjusted HR was 1.19 (95% CI: 0.99-1.43). CONCLUSION: Having more children was associated with a higher risk of CHD later in life, whereas breastfeeding was associated with a lower CHD risk. Women who both had children and breastfed did have a non-significantly higher risk of CHD.
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Two cohort studies showed that a longer length of breastfeeding is associated with reduced morbidity from coronary heart disease compared with never breastfed.
“Two cohort studies showed that a longer length of breastfeeding was associated with reduced morbidity from coronary heart disease compared with never breastfed.115 116”
From Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review (2020) · cites this paper as [115]
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References 36 · Cited by 80
- Authors
- Peters, S. A., van der Schouw, Y. T., Wood, A. M., Sweeting, M. J., Moons, K. G., Weiderpass, E., Arriola, L., Benetou, V., Boeing, H., Bonnet, F., Butt, S. T., Clavel-Chapelon, F., Drake, I., Gavrila, D., Key, T. J., Klinaki, E., Krogh, V., Kühn, T., Lassale, C., Masala, G., Matullo, G., Merritt, M., Molina-Portillo, E., Moreno-Iribas, C., Nøst, T. H., Olsen, A., Onland-Moret, N. C., Overvad, K., Panico, S., Redondo, M. L., Tjønneland, A., Trichopoulou, A., Tumino, R., Turzanski-Fortner, R., Tzoulaki, I., Wennberg, P., Winkvist, A., Thompson, S. G., Di Angelantonio, E., Riboli, E., Wareham, N. J., Danesh, J., & Butterworth, A. S.
- Affiliations
- The George Institute for Global Health (GB)
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- University of Cambridge (GB)
- University Medical Center Utrecht (NL)
- Karolinska Institutet (SE)
- Basque Government (ES)
- National and Kapodistrian University of Athens (GR)
- German Institute of Human Nutrition (DE)
- Centre Hospitalier Universitaire de Rennes (FR)
- Lund University (SE)
- INSERM, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones, and Women's Health Team, Institut Gustave Roussy, Villejuif, France
- Instituto Murciano de Investigación Biosanitaria (ES)
- University of Oxford (GB)
- Hellenic Health Foundation (GR)
- Fondazione IRCCS Istituto Nazionale dei Tumori (IT)
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
- Imperial College London (GB)
- Istituto per lo Studio e la Prevenzione Oncologica (IT)
- Italian institute for Genomic Medicine (IT)
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Public Health Institute of Navarra, Pamplona, Spain
- UiT The Arctic University of Norway (NO)
- Danish Cancer Society (DK)
- Aarhus University (DK)
- Federico II University Hospital (IT)
- Gobierno del Principado de Asturias (ES)
- Azienda Usl 8 Arezzo (IT)
- Umeå University (SE)
- University of Gothenburg (SE)
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
- Corresponding author
- Peters, Sanne AE
- ORCID
- Peters, Sanne AE
- Wood, Angela M
- Sweeting, Michael J
- Moons, Karel GM
- Weiderpass, Elisabete
- Arriola, Larraitz
- Benetou, Vassiliki
- Boeing, Heiner
- Bonnet, Fabrice
- Drake, Isabel
- Key, Timothy J
- Klinaki, Eleni
- Krogh, Vittorio
- Lassale, Camille
- Masala, Giovanna
- Matullo, Giuseppe
- Merritt, Melissa
- Nøst, Therese H
- Olsen, Anja
- Overvad, Kim
- Panico, Salvatore
- Tjønneland, Anne
- Trichopoulou, Antonia
- Tumino, Rosario
- Tzoulaki, Ioanna
- Wennberg, Patrik
- Winkvist, Anna
- Thompson, Simon G
- Wareham, Nicholas J
- Danesh, John
- Butterworth, Adam S
- Venue
- European Journal of Preventive Cardiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-07-10
- Volume
- 23
- Issue
- 16
- Pages
- 1755-1765
- ISSN
- 2047-4873 (ISSN-L)
- 2047-4881
- PMC
- PMC6217919
- OpenAlex
- W2466382971
- Cited by
- 80
- References
- 36
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 9 · 2023: 13 · 2022: 10 · 2021: 12 · 2020: 9 · 2019: 10 · 2018: 5 · 2017: 4 · 2016: 1
- FWCI
- 3.58
- Type
- journal article
- Language
- en
- Update notices
- correction (2016-11-22)
- Open access
- green
- europepmc.org
- Locations
- European Journal of Preventive Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
- HAL (submittedVersion, other-oa)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- UCL Discovery (University College London) (submittedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Scopus (Elsevier) (submittedVersion)
- Research Portal (Queen's University Belfast) (submittedVersion)
- Spiral (Imperial College London) (submittedVersion)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Apollo
- Funders
- Compagnia di San Paolo (MR/M012190/1)
- Cancer Research UK (MR/M012190/1, 16491, A16491, 570/A16491, 30194)
- National Institute for Health and Care Research (NF-SI-0512-10165, NF-SI-0512-10135)
- British Heart Foundation (MR/L003120/1, G0800270, SP/09/002, RG/08/014, RG/13/13/30194, RG/08/014/24067)
- European Commission (MR/M012190/1, 279233)
- Cancerfonden
- Human Genetics Foundation-Torino
- Associazione Iblea per la Ricerca Epidemiologica
- Hellenic Health Foundation (MR/M012190/1)
- Medical Research Council (MC_UU_12015/1, M012190/1, MC_PC_13048, MR/M012190, SP/09/002, MR/M012190/1, G0800270, MR/L003120, MR/L003120/1)
- FP7 Ideas: European Research Council (268834)
- Topics
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Health Sciences › Medicine › Epidemiology › Breastfeeding Practices and Influences
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Keywords
- parity, breastfeeding, coronary artery disease, number of children, cardiovascular risk, EPIC cohort
- MeSH terms
- Adult, Breast Feeding, Coronary Disease, Europe, Female, Follow-Up Studies, Forecasting, Humans, Middle Aged, Parity, Population Surveillance, Pregnancy, Prospective Studies, Risk Factors, Incidence, Age of Onset, Risk Assessment
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