“Ikigai”, subjective wellbeing, as a modifier of the parity-cardiovascular mortality association ― the Japan collaborative cohort study ―

Background: Nulliparity is associated with an excess risk of cardiovascular disease (CVD). “Ikigai”, subjective wellbeing in Japan, is associated with reduced risk of CVD. The impact of ikigai on the association between parity and the risk of CVD, however, has not been reported. Methods and Results: A total of 39,870 Japanese women aged 40–79 years without a history of CVD, cancer or insufficient information at baseline in 1988–1990, were enrolled and followed until the end of 2009. They were categorized into 7 groups according to parity number 0–≥6. Using Cox regression hazard modeling, the associations between parity and mortality from stroke, coronary artery disease, and total CVD were investigated. During the follow-up period, 2,121 total CVD deaths were documented. No association was observed between parity and stroke and CVD mortality in women with ikigai, but there was an association in those without ikigai. The multivariable hazard ratios of stroke and total CVD mortality for nulliparous women without ikigai vs. those with 1 child were 1.87 (95% CI: 1.15–3.05) and 1.46 (95% CI: 1.07–2.01), respectively, and that for stroke mortality in high parity women without ikigai was 1.56 (95% CI: 1.00–2.45). Conclusions: Nulliparous or high parity women without ikigai had higher mortality from stroke and/or total CVD, suggesting that ikigai attenuated the association between parity and CVD mortality in Japanese women.