title: Parity, breastfeeding and risk of coronary heart disease: A pan-European case-cohort study.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: The George Institute for Global Health, University of Oxford, Oxford, UK Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands sanne.peters@georgeinstitute.ox.ac.uk.
authors.forename: Sanne Ae
authors.initials: SA
authors.lastname: Peters
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
authors.affiliation: Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics at the University of Cambridge, UK.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Wood
authors.affiliation: Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sweeting
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Karel Gm
authors.initials: KG
authors.lastname: Moons
authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland.
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
authors.affiliation: Public Health Division of Gipuzkoa, Instituto Bio-Donostia, Basque Government, CIBERESP, Spain.
authors.forename: Larraitz
authors.initials: L
authors.lastname: Arriola
authors.affiliation: WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece Hellenic Health Foundation, Athens, Greece.
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Benetou
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, Germany.
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.affiliation: Centre Hospitalier Universitaire Rennes, University of Rennes, Villejuif, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bonnet
authors.affiliation: Department of Surgery, Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
authors.forename: Salma T
authors.initials: ST
authors.lastname: Butt
authors.affiliation: INSERM, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones, and Women's Health Team, Institut Gustave Roussy, Villejuif, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Clavel-Chapelon
authors.affiliation: Department of Clinical Science, Lund University, Malmö, Sweden.
authors.forename: Isabel
authors.initials: I
authors.lastname: Drake
authors.affiliation: Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Diana
authors.initials: D
authors.lastname: Gavrila
authors.affiliation: Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Key
authors.affiliation: Hellenic Health Foundation, Athens, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Klinaki
authors.affiliation: Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Krogh
authors.affiliation: German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Kühn
authors.affiliation: Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
authors.forename: Camille
authors.initials: C
authors.lastname: Lassale
authors.affiliation: Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Masala
authors.affiliation: Human Genetics Foundation, Turin, Italy Department of Medical Sciences, University of Turin, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Matullo
authors.affiliation: Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
authors.forename: Melissa
authors.initials: M
authors.lastname: Merritt
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Spain Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Molina-Portillo
authors.affiliation: Public Health Institute of Navarra, Pamplona, Spain Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Madrid, Spain.
authors.forename: Conchi
authors.initials: C
authors.lastname: Moreno-Iribas
authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
authors.forename: Therese H
authors.initials: TH
authors.lastname: Nøst
authors.affiliation: Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Anja
authors.initials: A
authors.lastname: Olsen
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: N Charlotte
authors.initials: NC
authors.lastname: Onland-Moret
authors.affiliation: Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
authors.affiliation: Public Health Directorate, Asturias, Spain.
authors.forename: M Luisa
authors.initials: ML
authors.lastname: Redondo
authors.affiliation: Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.affiliation: WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece Hellenic Health Foundation, Athens, Greece.
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.affiliation: Cancer Registry and Histopathology Unit, Civic - M.P. Arezzo Hospital, ASP Ragusa, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.affiliation: German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany.
authors.forename: Renée
authors.initials: R
authors.lastname: Turzanski-Fortner
authors.affiliation: Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Tzoulaki
authors.affiliation: Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
authors.forename: Patrik
authors.initials: P
authors.lastname: Wennberg
authors.affiliation: Nutritional Research, Umeå University, Umeå, Sweden Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Winkvist
authors.affiliation: Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics at the University of Cambridge, UK.
authors.forename: Simon G
authors.initials: SG
authors.lastname: Thompson
authors.affiliation: Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Di Angelantonio
authors.affiliation: Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.affiliation: Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
authors.affiliation: Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics at the University of Cambridge, UK Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
authors.forename: John
authors.initials: J
authors.lastname: Danesh
authors.affiliation: Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics at the University of Cambridge, UK.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Butterworth
mesh_terms: D000328:Adult; D017668:Age of Onset; D001942:Breast Feeding; D003327:Coronary Disease / Q000453:epidemiology* / Q000209:etiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D010298:Parity; D011159:Population Surveillance; D011247:Pregnancy; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
keywords: Parity; Women; breastfeeding; coronary heart disease