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

Sanne Ae Peters; Yvonne T van der Schouw; Angela M Wood; Michael J Sweeting; Karel Gm 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

doi:10.1177/2047487316658571

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

Sanne Ae Peters, Yvonne T van der Schouw, Angela M Wood, Michael J Sweeting, Karel Gm 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 MasalaGiuseppe 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

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

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.

Original language	English
Journal	European Journal of Preventive Cardiology
Volume	23
Issue number	16
Pages (from-to)	1755-1765
Number of pages	11
ISSN	2047-4873
DOIs	https://doi.org/10.1177/2047487316658571
Publication status	Published - 2016

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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., ... Butterworth, A. S. (2016). Parity, breastfeeding and risk of coronary heart disease: A pan-European case-cohort study. European Journal of Preventive Cardiology, 23(16), 1755-1765. Advance online publication. https://doi.org/10.1177/2047487316658571

@article{89e71f98062f46a99193107dc292c396,

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

abstract = "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.",

author = "Peters, {Sanne Ae} and {van der Schouw}, {Yvonne T} and Wood, {Angela M} and Sweeting, {Michael J} and Moons, {Karel Gm} and Elisabete Weiderpass and Larraitz Arriola and Vassiliki Benetou and Heiner Boeing and Fabrice Bonnet and Butt, {Salma T} and Fran{\c c}oise Clavel-Chapelon and Isabel Drake and Diana Gavrila and Key, {Timothy J} and Eleni Klinaki and Vittorio Krogh and Tilman K{\"u}hn and Camille Lassale and Giovanna Masala and Giuseppe Matullo and Melissa Merritt and Elena Molina-Portillo and Conchi Moreno-Iribas and N{\o}st, {Therese H} and Anja Olsen and Onland-Moret, {N Charlotte} and Kim Overvad and Salvatore Panico and Redondo, {M Luisa} and Anne Tj{\o}nneland and Antonia Trichopoulou and Rosario Tumino and Ren{\'e}e Turzanski-Fortner and Ioanna Tzoulaki and Patrik Wennberg and Anna Winkvist and Thompson, {Simon G} and {Di Angelantonio}, Emanuele and Elio Riboli and Wareham, {Nicholas J} and John Danesh and Butterworth, {Adam S}",

note = "{\textcopyright} The European Society of Cardiology 2016.",

year = "2016",

doi = "10.1177/2047487316658571",

language = "English",

volume = "23",

pages = "1755--1765",

journal = "European Journal of Preventive Cardiology",

issn = "2047-4873",

publisher = "SAGE Publications",

number = "16",

}

Peters, SA, van der Schouw, YT, Wood, AM, Sweeting, MJ, Moons, KG, Weiderpass, E, Arriola, L, Benetou, V, Boeing, H, Bonnet, F, Butt, ST, Clavel-Chapelon, F, Drake, I, Gavrila, D, Key, TJ, Klinaki, E, Krogh, V, Kühn, T, Lassale, C, Masala, G, Matullo, G, Merritt, M, Molina-Portillo, E, Moreno-Iribas, C, Nøst, TH, Olsen, A, Onland-Moret, NC, Overvad, K, Panico, S, Redondo, ML, Tjønneland, A, Trichopoulou, A, Tumino, R, Turzanski-Fortner, R, Tzoulaki, I, Wennberg, P, Winkvist, A, Thompson, SG, Di Angelantonio, E, Riboli, E, Wareham, NJ, Danesh, J & Butterworth, AS 2016, 'Parity, breastfeeding and risk of coronary heart disease: A pan-European case-cohort study', European Journal of Preventive Cardiology, vol. 23, no. 16, pp. 1755-1765. https://doi.org/10.1177/2047487316658571

TY - JOUR

T1 - Parity, breastfeeding and risk of coronary heart disease

T2 - A pan-European case-cohort study

AU - Peters, Sanne Ae

AU - van der Schouw, Yvonne T

AU - Wood, Angela M

AU - Sweeting, Michael J

AU - Moons, Karel Gm

AU - Weiderpass, Elisabete

AU - Arriola, Larraitz

AU - Benetou, Vassiliki

AU - Boeing, Heiner

AU - Bonnet, Fabrice

AU - Butt, Salma T

AU - Clavel-Chapelon, Françoise

AU - Drake, Isabel

AU - Gavrila, Diana

AU - Key, Timothy J

AU - Klinaki, Eleni

AU - Krogh, Vittorio

AU - Kühn, Tilman

AU - Lassale, Camille

AU - Masala, Giovanna

AU - Matullo, Giuseppe

AU - Merritt, Melissa

AU - Molina-Portillo, Elena

AU - Moreno-Iribas, Conchi

AU - Nøst, Therese H

AU - Olsen, Anja

AU - Onland-Moret, N Charlotte

AU - Overvad, Kim

AU - Panico, Salvatore

AU - Redondo, M Luisa

AU - Tjønneland, Anne

AU - Trichopoulou, Antonia

AU - Tumino, Rosario

AU - Turzanski-Fortner, Renée

AU - Tzoulaki, Ioanna

AU - Wennberg, Patrik

AU - Winkvist, Anna

AU - Thompson, Simon G

AU - Di Angelantonio, Emanuele

AU - Riboli, Elio

AU - Wareham, Nicholas J

AU - Danesh, John

AU - Butterworth, Adam S

PY - 2016

Y1 - 2016

N2 - 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.

AB - 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.

U2 - 10.1177/2047487316658571

DO - 10.1177/2047487316658571

M3 - Journal article

C2 - 27378766

SN - 2047-4873

VL - 23

SP - 1755

EP - 1765

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

IS - 16

ER -

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

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