First-born Children Are ‘At Lower Risk Of Heart Attacks And Strokes’ – Researchers

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First-born children have a lower risk of cardiovascular events such as heart attacks and strokes than brothers and sisters born later, but people who are part of a large family with many siblings have an increased risk of these events, a large population study suggests.

Children laughing
It is well-known that family history – the health of parents and grandparents – has an impact on a person’s health, including their risk of cardiovascular events, but now there is growing interest in what influence the make-up of a person’s immediate family, such as the number and age of siblings, may have.
Researchers at Lund University in Malmö, Sweden, therefore accessed data on 1.36 million men and 1.32 million women born between 1932 and 1960 and aged between 30 and 58 years in 1990. Data on fatal and non-fatal cardiovascular and coronary events over the next 25 years were retrieved from national registers.

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Analysis of the data showed that first-borns had a lower risk of non-fatal cardiovascular and coronary events than siblings born later. First-born men had a higher risk of death than second and third-born siblings, while first-born women had a higher risk of death than second-born siblings, but equal to further siblings.

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When family size was looked at, when compared with men with no siblings, men with one or two siblings had a lower risk of cardiovascular events, while those with four or more siblings had a higher risk. Similarly, compared with men with no siblings, men with more than one sibling had a lower risk of death, while those with three or more siblings had an increased risk of coronary events.
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A similar pattern was seen in women. Compared with those with no siblings, women with three or more siblings had an increased risk of cardiovascular events, while those with two or more siblings had an increased risk of coronary events. Women with one or more siblings had a lower risk of death.


The authors point out that although their observational study cannot establish cause because policies to support families and the number of children currently vary widely between countries their findings could have implications for public health. They said that the number and rank order of siblings could be of importance for risk of cardiovascular disease and mortality, but more research was needed to understand the links.

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“Future research should be directed to find biological or social mechanisms linking the status of being first born to lower risk of cardiovascular disease, as indicated by our observational findings,” they concluded. The results are published in the online journal BMJ Open.

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