title: The association of reproductive history with all-cause and cardiovascular mortality in older women: the Rancho Bernardo Study.
abstract: OBJECTIVE
  To examine associations of gravidity and parity with all-cause, cardiovascular disease (CVD), and coronary heart disease (CHD) mortality in postmenopausal women.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Rancho Bernardo, a southern California community.
  
  
  METHODS
  One thousand two hundred ninety-four postmenopausal women ages 50-96 who attended a 1984-87 research clinic visit at which reproductive and medical histories were obtained and who were followed through 2007.
  
  
  METHODS
  None.
  
  
  METHODS
  All-cause, CVD, CHD, and non-CHD CVD mortality, determined by nosologist-coded death certificates.
  
  
  RESULTS
  Average baseline age was 70.6 ± 9.2. Numbers of pregnancies ranged from 0 to 13 (median = 2); births ranged from 0 to 11 (median = 2). During a median of 19.3 years of follow-up, 707 women (54.6%) died, with 46.5% attributed to CVD, 20.5% to CHD, and 26.0% to non-CHD CVD. Trend analyses showed inverse associations of gravidity with CVD mortality and non-CHD CVD mortality. Women with four or more pregnancies were less likely than nulligravidas to have fatal CVD (hazard ratio [HR] = 0.63, 95% confidence interval [CI] = 0.40-0.99) and non-CHD CVD (HR = 0.48, 95% CI = 0.26-0.91) independent of age, years postmenopause, obesity, and HDL. Associations increased after the first decade of follow-up. Parity and gravidity were not associated with overall or CHD mortality.
  
  
  CONCLUSIONS
  High gravidity was associated with reduced CVD and non-CHD CVD mortality in postmenopausal women. Protective associations could reflect biological mechanisms that occur with repeated pregnancy or greater social support related to family size among multiparous women.
authors: Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego, California 92093-0607, USA.
authors: Marni B
authors: MB
authors: Jacobs
authors: Donna
authors: D
authors: Kritz-Silverstein
authors: Deborah L
authors: DL
authors: Wingard
authors: Elizabeth
authors: E
authors: Barrett-Connor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D002140:California / Q000453:epidemiology; D003327:Coronary Disease / Q000401:mortality*; D003644:Death Certificates; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D010298:Parity; D017698:Postmenopause; D011247:Pregnancy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012098:Reproduction; D012307:Risk Factors