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Patterns of alcohol consumption and ischaemic heart disease in culturally divergent countries: the Prospective Epidemiological Study of Myocardial Infarction (PRIME)

BMJ 2010; 341 doi: (Published 24 November 2010) Cite this as: BMJ 2010;341:c6077
  1. Jean-Bernard Ruidavets, medical doctor, researcher in epidemiology1,
  2. Pierre Ducimetière, senior epidemiology researcher, study coordinator2,
  3. Alun Evans, emeritus professor of epidemiology3,
  4. Michèle Montaye, medical doctor4,
  5. Bernadette Haas, medical doctor, researcher in epidemiology5,
  6. Annie Bingham, research epidemiologist, study coordinator6,
  7. John Yarnell, reader in cardiovascular epidemiology3,
  8. Philippe Amouyel, professor of public health4,
  9. Dominique Arveiler, medical doctor, researcher in epidemiology5,
  10. Frank Kee, professor of public health medicine3,
  11. Vanina Bongard, associate professor of medicine1,
  12. Jean Ferrières, professor of medicine7
  1. 1Department of Epidemiology, INSERM U558, Toulouse University School of Medicine, Toulouse, France
  2. 2INSERM-Paris XI University, Villejuif, France
  3. 3UK Clinical Research Collaboration Centre of Excellence for Public Health, Queen’s University Belfast, Belfast, UK
  4. 4Department of Epidemiology and Public Health, INSERM U744, Pasteur Institute of Lille, Lille, France
  5. 5Department of Epidemiology and Public Health, EA 3430, Medical Faculty, University of Strasbourg, Strasbourg, France
  6. 6INSERM U970, Paul Brousse Hospital, Villejuif, France
  7. 7Department of Cardiology B and Department of Epidemiology, INSERM U558, Toulouse University Hospital, Toulouse, France
  1. Correspondence to: J-B Ruidavets jean-bernard.ruidavets{at}
  • Accepted 9 September 2010


Objective To investigate the effect of alcohol intake patterns on ischaemic heart disease in two countries with contrasting lifestyles, Northern Ireland and France.

Design Cohort data from the Prospective Epidemiological Study of Myocardial Infarction (PRIME) were analysed. Weekly alcohol consumption, incidence of binge drinking (alcohol >50 g on at least one day a week), incidence of regular drinking (at least one day a week, and alcohol <50 g if on only one occasion), volume of alcohol intake, frequency of consumption, and types of beverage consumed were assessed once at inclusion. All coronary events that occurred during the 10 year follow-up were prospectively registered. The relation between baseline characteristics and incidence of hard coronary events and angina events was assessed by Cox’s proportional hazards regression analysis.

Setting One centre in Northern Ireland (Belfast) and three centres in France (Lille, Strasbourg, and Toulouse).

Participants 9778 men aged 50-59 free of ischaemic heart disease at baseline, who were recruited between 1991 and 1994.

Main outcome measures Incident myocardial infarction and coronary death (“hard” coronary events), and incident angina pectoris.

Results A total of 2405 men from Belfast and 7373 men from the French centres were included in the analyses, 1456 (60.5%) and 6679 (90.6%) of whom reported drinking alcohol at least once a week, respectively. Among drinkers, 12% (173/1456) of men in Belfast drank alcohol every day compared with 75% (5008/6679) of men in France. Mean alcohol consumption was 22.1 g/day in Belfast and 32.8 g/day in France. Binge drinkers comprised 9.4% (227/2405) and 0.5% (33/7373) of the Belfast and France samples, respectively. A total of 683 (7.0%) of the 9778 participants experienced ischaemic heart disease events during the 10 year follow-up: 322 (3.3%) hard coronary events and 361 (3.7%) angina events. Annual incidence of hard coronary events per 1000 person years was 5.63 (95% confidence interval 4.69 to 6.69) in Belfast and 2.78 (95% CI 2.41 to 3.20) in France. After multivariate adjustment for classic cardiovascular risk factors and centre, the hazard ratio for hard coronary events compared with regular drinkers was 1.97 (95% CI 1.21 to 3.22) for binge drinkers, 2.03 (95% CI 1.41 to 2.94) for never drinkers, and 1.57 (95% CI 1.11 to 2.21) for former drinkers for the entire cohort. The hazard ratio for hard coronary events in Belfast compared with in France was 1.76 (95% CI 1.37 to 2.67) before adjustment, and 1.09 (95% CI 0.79 to 1.50) after adjustment for alcohol patterns and wine drinking. Only wine drinking was associated with a lower risk of hard coronary events, irrespective of the country.

Conclusions Regular and moderate alcohol intake throughout the week, the typical pattern in middle aged men in France, is associated with a low risk of ischaemic heart disease, whereas the binge drinking pattern more prevalent in Belfast confers a higher risk.


  • We thank the following organisations that allowed the recruitment of participants for the Prospective Epidemiological Study of Myocardial Infarction (PRIME): the health screening centres organised by the Social Security of Lille (Institut Pasteur), Strasbourg, Toulouse, and Tourcoing; the occupational medicine services of Haute-Garonne; the Urban Community of Strasbourg; the Association Inter-entreprises des Services Médicaux du Travail de Lille et environs; the Comité pour le Développement de la Médecine du Travail; the Mutuelle Générale des Postes, Télégraphes et Téléphones du Bas-Rhin; the Laboratoire d’Analyses de l’Institut de Chimie Biologique de la Faculté de Médecine de Strasbourg; the Department of Health (NI); and the Northern Ireland Chest Heart and Stroke Association. We also thank the Alliance Partnership Programme for its financial support and the following members of the event validation committees: L Guize; C Morrison; M-T Guillanneuf; and M Giroud.

  • Contributors: The authors were responsible for all the aspects of the study design; the collection, analysis, and the interpretation of the data; the writing of the report; and the decision to submit the article for publication. J-BR performed analyses and wrote the manuscript. PD, AE, and FK are the guarantors of data analyses and contributed to the redrafting of the manuscript.

  • Funding: PRIME was supported by grants from the Institut National de la Santé et de la Recherche Médicale (INSERM) and the Merck, Sharp & Dohme-Chibret Laboratory.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

  • Data sharing: Technical appendix and statistical code are available from Jean-Bernard Ruidavets (jean-bernard.ruidavets{at} Data are available from the PRIME study group (coordinating centre: Pierre Ducimetière, CESP, Villejuif, F-94807, France. pierre.ducimetiere{at} subject to an end user authorisation agreement.

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