Article open access publication

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

European Journal of Preventive Cardiology, SAGE Publications, ISSN 2047-4873

Volume 23, 16, 2016

DOI:10.1177/2047487316658571, Dimensions: pub.1006171449, PMC: PMC6217919, PMID: 27378766,



  1. (1) University of Oxford, grid.4991.5
  2. (2) University Medical Center Utrecht, grid.7692.a
  3. (3) The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics at the University of Cambridge, UK
  4. (4) University of Cambridge, grid.5335.0
  5. (5) Cancer Registry of Norway, grid.418941.1
  6. (6) Folkhälsans Forskningscentrum, grid.428673.c
  7. (7) Karolinska Institute, grid.4714.6
  8. (8) The Arctic University of Norway, grid.10919.30
  9. (9) Public Health Division of Gipuzkoa, Instituto Bio-Donostia, Basque Government, CIBERESP, Spain
  10. (10) Hellenic Health Foundation, grid.424637.0
  11. (11) National and Kapodistrian University of Athens, grid.5216.0
  12. (12) German Institute of Human Nutrition, grid.418213.d
  13. (13) Centre Hospitalier Universitaire Rennes, University of Rennes, Villejuif, France
  14. (14) Department of Surgery, Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
  15. (15) Institut Gustave Roussy, grid.14925.3b
  16. (16) Lund University, grid.4514.4
  17. (17) Instituto Murciano de Investigación Biosanitaria, grid.452553.0
  18. (18) Institute of Health Carlos III, grid.413448.e
  19. (19) Fondazione IRCCS Istituto Nazionale dei Tumori, grid.417893.0
  20. (20) German Cancer Research Center, grid.7497.d
  21. (21) Imperial College London, grid.7445.2
  22. (22) Istituto per lo Studio e la Prevenzione Oncologica, grid.417623.5
  23. (23) Human Genetics Foundation, grid.428948.b
  24. (24) University of Turin, grid.7605.4
  25. (25) Andalusian School of Public Health, grid.413740.5
  26. (26) Public Health Institute of Navarra, Pamplona, Spain
  27. (27) Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Madrid, Spain
  28. (28) Danish Cancer Society, grid.417390.8
  29. (29) Aalborg Hospital, grid.27530.33, North Denmark Region
  30. (30) Aarhus University, grid.7048.b, AU
  31. (31) University of Naples Federico II, grid.4691.a
  32. (32) Public Health Directorate, Asturias, Spain
  33. (33) Cancer Registry and Histopathology Unit, Civic – M.P. Arezzo Hospital, ASP Ragusa, Italy
  34. (34) Umeå University, grid.12650.30
  35. (35) University of Gothenburg, grid.8761.8


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.


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Times Cited: 24

Field Citation Ratio (FCR): 7.99

Relative Citation ratio (RCR): 1.73

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Green, Accepted