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The end points for this study were incident CVD (I00–I99); CHD (I20–I25); cerebrovascular disease (henceforth, “stroke”) (I60–I69), including hemorrhagic stroke (I61) and ischemic stroke (I63); major CVDs (ie, I21–I23, I60–I61, I63–I64 [any] and I00–I20, I24–I25, I27–I59, I62, I65–I88, I95–I99 [only where fatal]); and fatal CVDs (I00–I99).
Women with a self‐reported history of CHD or stroke at baseline were excluded (n=13 096), leaving 289 573 women for further analyses.
Moreover, some studies were restricted to fatal CVD end points,10, 11, 14 whereas others only examined specific types of CVD,12, 13 typically coronary heart disease (CHD), without evaluating other major types of incident CVD, such as ischemic and hemorrhagic stroke.
Major differences in breastfeeding practices, between and within populations, may also explain some of the discordance in study findings.15 Breastfeeding initiation rates are typically considerably higher and breastfeeding duration is typically longer in women from low‐ and middle‐income countries, compared with those in high‐income countries.
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A series of physical measurements were taken using standard methods and a blood sample was collected for long‐term storage.
Compared with parous women who had never breastfed, ever breastfeeding was associated with a significantly lower risk of Pregnancy causes substantial changes to the maternal cardiometabolic system, including weight gain, increased insulin resistance, and higher levels of circulating lipids.1, 2 Such pregnancy‐related cardiometabolic changes may reverse more quickly and more completely with breastfeeding, with several studies reporting that women who breastfeed have more favorable cardiometabolic profiles compared with women who do not breastfeed.3, 4, 5 Longer breastfeeding duration has also been associated with a lower risk of metabolic syndrome,6 hypertension,7, 8 and diabetes mellitus in later life,9 which may lead to long‐term protective benefits for cardiometabolic diseases.
Data linkage with health insurance agencies was performed every 6 months in each region to retrieve all hospitalized events occurring in that period for study participants.
Active follow‐up was performed annually to minimize attrition.
Detailed information on women's reproductive factors was also collected, including age at menarche; the number of pregnancies, abortions, and live births; and the total duration of any breastfeeding for each live birth.
From this, the mean duration of breastfeeding per child and cumulative lifetime duration of any breastfeeding for all children were calculated for parous women.
Methods and Results In 2004–2008, the nationwide China Kadoorie Biobank recruited 0.5 million individuals aged 30 to 79 years from 10 diverse regions across China.