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

Research output: Contribution to journalArticle


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.


  • 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
  • Françoise Clavel-Chapelon
  • 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
External organisations
  • University of Oxford
  • University Medical Center Utrecht
  • University of Cambridge
  • Folkhälsan Research Center
  • Biodonostia Health Research Institute
  • National and Kapodistrian University of Athens
  • German Institute of Human Nutrition
  • University of Rennes I
  • Centre for Research in Epidemiology and Population Health (CESP)
  • CIBER Epidemiology and Public Health (CIBERESP)
  • Hellenic Health Foundation, Athens
  • Istituto Nazionale dei Tumori
  • German Cancer Research Centre
  • Imperial College London
  • Cancer Research and Prevention Institute (ISPO)
  • University of Turin
  • University of Granada
  • Health Services Research on Chronic Patients Network
  • Danish Cancer Society Research Center
  • Aalborg University Hospital
  • University of Naples Federico II
  • Public Health Directorate
  • Civic and M.P Arezzo Hospital
  • Umeå University
  • University of Gothenburg
  • UiT The Arctic University of Norway, Tromsø
  • Karolinska Institutet
  • Cancer Registry of Norway, Institute of Population-Based Cancer Research
  • Murcia Regional Health Council
  • Human Genetics Foundation (HuGeF)
  • Health Research Institute of Navarra (IDISNA)
  • Aarhus University
  • Skåne University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems


  • breastfeeding, coronary heart disease, Parity, Women
Original languageEnglish
Pages (from-to)1755-1765
Number of pages11
JournalEuropean Journal of Preventive Cardiology
Issue number16
Publication statusPublished - 2016 Nov 1
Publication categoryResearch