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Breastfeeding History and Risk of Stroke Among Parous Postmenopausal Women in the Women's Health Initiative.
J Am Heart Assoc. 2018 09 04; 7(17):e008739.JA

Abstract

Background Stroke is the third leading cause of death among US Hispanic and non-Hispanic black women aged 65 and older. One factor that may protect against stroke is breastfeeding. Few studies have assessed the association between breastfeeding and stroke and whether this association differs by race and ethnicity. Methods and Results Data were taken from the Women's Health Initiative Observational Study with follow-up through 2010; adjusted hazard ratios for stroke subsequent to childbirth were estimated with Cox regression models accounting for left and right censoring, overall and stratified by race/ethnicity. Of the 80 191 parous women in the Women's Health Initiative Observational Study, 2699 (3.4%) had experienced a stroke within a follow-up period of 12.6 years. The average age was 63.7 years at baseline. Fifty-eight percent (n=46 699) reported ever breastfeeding; 83% were non-Hispanic white, 8% were non-Hispanic black, 4% were Hispanic, and 5% were of other race/ethnicity. After adjustment for nonmodifiable potential confounders, compared with women who had never breastfed, women who reported ever breastfeeding had a 23% lower risk of stroke (adjusted hazard ratio=0.77; 95% confidence interval 0.70-0.83). This association was strongest for non-Hispanic black women (adjusted hazard ratio=0.52; 95% confidence interval 0.37-0.71). Further, breastfeeding for a relatively short duration (1-6 months) was associated with a 19% lower risk of stroke (adjusted hazard ratios=0.81; 95% confidence interval 0.74-0.89). This association appeared stronger with longer breastfeeding duration and among non-Hispanic white and non-Hispanic black women (test for trend P<0.01). Conclusions Study results show an association and dose-response relationship between breastfeeding and lower risk of stroke among postmenopausal women after adjustment for multiple stroke risk factors and lifestyle variables. Further investigation is warranted.

Authors+Show Affiliations

1 Department of Preventive Medicine and Public Health School of Medicine-Wichita University of Kansas Wichita KS.2 Center for Biostatistics Department of Biomedical Informatics The Ohio State University Columbus OH.1 Department of Preventive Medicine and Public Health School of Medicine-Wichita University of Kansas Wichita KS.3 HealthPartners Institute Minneapolis MN.4 University of Connecticut Storrs CT.5 Northwestern University Chicago IL.6 Department of Neurology University of Massachusetts Medical School Worcester MA.7 Department of Medicine University of Florida College of Medicine Gainesville FL.8 RAND Corporation Santa Monica CA.9 Department of Family Medicine University of Kansas Medical Center Kansas City KS.10 School of Nursing University of Kansas Medical Center Kansas City KS.11 Stanford Prevention Research Center Stanford University Stanford CA.

Pub Type(s)

Journal Article
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30371157

Citation

Jacobson, Lisette T., et al. "Breastfeeding History and Risk of Stroke Among Parous Postmenopausal Women in the Women's Health Initiative." Journal of the American Heart Association, vol. 7, no. 17, 2018, pp. e008739.
Jacobson LT, Hade EM, Collins TC, et al. Breastfeeding History and Risk of Stroke Among Parous Postmenopausal Women in the Women's Health Initiative. J Am Heart Assoc. 2018;7(17):e008739.
Jacobson, L. T., Hade, E. M., Collins, T. C., Margolis, K. L., Waring, M. E., Van Horn, L. V., Silver, B., Sattari, M., Bird, C. E., Kimminau, K., Wambach, K., & Stefanick, M. L. (2018). Breastfeeding History and Risk of Stroke Among Parous Postmenopausal Women in the Women's Health Initiative. Journal of the American Heart Association, 7(17), e008739. https://doi.org/10.1161/JAHA.118.008739
Jacobson LT, et al. Breastfeeding History and Risk of Stroke Among Parous Postmenopausal Women in the Women's Health Initiative. J Am Heart Assoc. 2018 09 4;7(17):e008739. PubMed PMID: 30371157.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Breastfeeding History and Risk of Stroke Among Parous Postmenopausal Women in the Women's Health Initiative. AU - Jacobson,Lisette T, AU - Hade,Erinn M, AU - Collins,Tracie C, AU - Margolis,Karen L, AU - Waring,Molly E, AU - Van Horn,Linda V, AU - Silver,Brian, AU - Sattari,Maryam, AU - Bird,Chloe E, AU - Kimminau,Kim, AU - Wambach,Karen, AU - Stefanick,Marcia L, PY - 2018/10/30/entrez PY - 2018/10/30/pubmed PY - 2019/11/22/medline KW - breastfeeding, human lactation KW - cerebrovascular disease/stroke KW - epidemiology KW - health disparities KW - risk factor KW - women and minorities SP - e008739 EP - e008739 JF - Journal of the American Heart Association JO - J Am Heart Assoc VL - 7 IS - 17 N2 - Background Stroke is the third leading cause of death among US Hispanic and non-Hispanic black women aged 65 and older. One factor that may protect against stroke is breastfeeding. Few studies have assessed the association between breastfeeding and stroke and whether this association differs by race and ethnicity. Methods and Results Data were taken from the Women's Health Initiative Observational Study with follow-up through 2010; adjusted hazard ratios for stroke subsequent to childbirth were estimated with Cox regression models accounting for left and right censoring, overall and stratified by race/ethnicity. Of the 80 191 parous women in the Women's Health Initiative Observational Study, 2699 (3.4%) had experienced a stroke within a follow-up period of 12.6 years. The average age was 63.7 years at baseline. Fifty-eight percent (n=46 699) reported ever breastfeeding; 83% were non-Hispanic white, 8% were non-Hispanic black, 4% were Hispanic, and 5% were of other race/ethnicity. After adjustment for nonmodifiable potential confounders, compared with women who had never breastfed, women who reported ever breastfeeding had a 23% lower risk of stroke (adjusted hazard ratio=0.77; 95% confidence interval 0.70-0.83). This association was strongest for non-Hispanic black women (adjusted hazard ratio=0.52; 95% confidence interval 0.37-0.71). Further, breastfeeding for a relatively short duration (1-6 months) was associated with a 19% lower risk of stroke (adjusted hazard ratios=0.81; 95% confidence interval 0.74-0.89). This association appeared stronger with longer breastfeeding duration and among non-Hispanic white and non-Hispanic black women (test for trend P<0.01). Conclusions Study results show an association and dose-response relationship between breastfeeding and lower risk of stroke among postmenopausal women after adjustment for multiple stroke risk factors and lifestyle variables. Further investigation is warranted. SN - 2047-9980 UR - https://www.unboundmedicine.com/medline/citation/30371157/Breastfeeding_History_and_Risk_of_Stroke_Among_Parous_Postmenopausal_Women_in_the_Women's_Health_Initiative_ L2 - http://www.ahajournals.org/doi/full/10.1161/JAHA.118.008739?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -