In Reply We thank Aguilo et al for their comment on our article.1 As they highlight, nonbreastfed individuals may have increased risk of cardiovascular disease and adverse lipid profiles in childhood and adulthood. However, the role of breastfeeding in our findings, particularly in terms of confounding, is minimal. For example, previously published data from our sample found no difference in cholesterol levels between breastfed and nonbreastfed individuals (at a mean age of 31 years), and no association was observed between breastfeeding and carotid intimamedia thickness (cIMT) or carotid artery compliance.2 Consistent with these data, among a subset of 422 individuals included in our analysis for which breastfeeding status was collected, we observed no difference in non–high-density lipoprotein cholesterol at each life stage between individuals who were breastfed and individuals who were not. Collectively, the data from our sample suggest that lipid levels are not on the pathway, and therefore, our results would not be confounded by breastfeeding status. Indeed, in the subset for which this information was available, we observed a negligible change in our estimates after adjustment for breastfeeding status (accumulated odds in model adjusted for sex: odds ratio [OR], 1.66; 95% credible interval, 1.22-2.18; accumulated odds in model adjusted for sex and breastfeeding status: OR, 1.65; 95% credible interval, 1.22-2.18; life-stage–specific OR and relative importance point estimates the same for both models).
Armstrong MK, Fraser BJ, Magnussen CG. Early-Life Initiation of Primary Prevention Strategies to Reduce Atherosclerosis Risk—Reply. JAMA Cardiol. 2021;6(12):1467–1468. doi:10.1001/jamacardio.2021.3951
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