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Parity, breastfeeding and risk of coronary heart disease: A pan-European case-cohort study

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Peters, SA 
van der Schouw, YT 
Wood, AM 
Sweeting, MJ 
Moons, KG 


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.



Parity, Women, breastfeeding, coronary heart disease

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European Journal of Preventive Cardiology

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SAGE Publications Ltd
MRC (MC_PC_13048)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0512-10135)
Medical Research Council (MC_UU_12015/1)
Medical Research Council (G0700463)
Medical Research Council (G0800270)
Medical Research Council (MR/L003120/1)
Medical Research Council (MC_U106179471)
European Research Council (268834)
British Heart Foundation (None)
British Heart Foundation (None)
Medical Research Council (G0700463/1)
Medical Research Council (G0800270/1)
EPIC-CVD has been supported by the European Union Framework 7 (HEALTH-F2-2012-279233), the European Research Council (268834), the UK Medical Research Council (G0800270 and MR/L003120/1), the British Heart Foundation (SP/09/002 and RG/08/014 and RG13/13/30194), and the UK National Institute of Health Research. EPIC Asturias was also supported by the Regional Government of Asturias. EPIC-Greece is also supported by the Hellenic Health Foundation. EPIC-Oxford was also supported by the UK Medical Research Council (MR/M012190/1) and Cancer Research UK (570/A16491). EPIC-Ragusa was also supported by the Sicilian Government, AIRE ONLUS Ragusa, and AVIS Ragusa. EPIC-Sweden was also supported by Swedish Cancer Society, Swedish Scientific Council, and Regional Government of Skåne and Västerbotten (Sweden). EPIC-Turin was also supported also by the Compagnia di San Paolo and the Human Genetics Foundation-Torino (HuGeF).