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

  • Sanne A E Peters
  • Yvonne T. Van Der Schouw
  • Angela M. Wood
  • Michael J. Sweeting
  • Karel G M Moons
  • Elisabete Weiderpass
  • Larraitz Arriola
  • Vassiliki Benetou
  • Heiner Boeing
  • Fabrice Bonnet
  • Salma T. Butt
  • Françoise Clavel-Chapelon
  • Isabel Drake
  • Diana Gavrila
  • Timothy J. Key
  • Eleni Klinaki
  • Vittorio Krogh
  • Tilman Kühn
  • Camille Lassale
  • Giovanna Masala
  • Giuseppe Matullo
  • Melissa Merritt
  • Elena Molina-Portillo
  • Conchi Moreno-Iribas
  • Therese H. Nøst
  • Anja Olsen
  • N. Charlotte Onland-Moret
  • Kim Overvad
  • Salvatore Panico
  • M. Luisa Redondo
  • Anne Tjønneland
  • Antonia Trichopoulou
  • Rosario Tumino
  • Renée Turzanski-Fortner
  • Ioanna Tzoulaki
  • Patrik Wennberg
  • Anna Winkvist
  • Simon G. Thompson
  • Emanuele Di Angelantonio
  • Elio Riboli
  • Nicholas J. Wareham
  • John Danesh
  • Adam S. Butterworth
Publishing year: 2016-11-01
Language: English
Pages: 1755-1765
Publication/Series: European Journal of Preventive Cardiology
Volume: 23
Issue: 16
Document type: Journal article
Publisher: SAGE Publications Inc.

Abstract english

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.


  • Cardiac and Cardiovascular Systems
  • breastfeeding
  • coronary heart disease
  • Parity
  • Women


  • Surgery
  • Nutrition Epidemiology
  • ISSN: 2047-4873
Isabel Drake
E-mail: isabel [dot] drake [at] med [dot] lu [dot] se

Lund University Diabetes Centre, CRC, SUS Malmö, Jan Waldenströms gata 35, House 91:12. SE-214 28 Malmö. Telephone: +46 40 39 10 00