title: Patterns of alcohol consumption and ischaemic heart disease in culturally divergent countries: the Prospective Epidemiological Study of Myocardial Infarction (PRIME).
abstract: OBJECTIVE
  To investigate the effect of alcohol intake patterns on ischaemic heart disease in two countries with contrasting lifestyles, Northern Ireland and France.
  
  
  METHODS
  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.
  
  
  METHODS
  One centre in Northern Ireland (Belfast) and three centres in France (Lille, Strasbourg, and Toulouse).
  
  
  METHODS
  9778 men aged 50-59 free of ischaemic heart disease at baseline, who were recruited between 1991 and 1994.
  
  
  METHODS
  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.
authors.affiliation: Department of Epidemiology, INSERM U558, Toulouse University School of Medicine, Toulouse, France. jean-bernard.ruidavets@cict.fr
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Ruidavets
authors.forename: Pierre
authors.initials: P
authors.lastname: Ducimetière
authors.forename: Alun
authors.initials: A
authors.lastname: Evans
authors.forename: Michèle
authors.initials: M
authors.lastname: Montaye
authors.forename: Bernadette
authors.initials: B
authors.lastname: Haas
authors.forename: Annie
authors.initials: A
authors.lastname: Bingham
authors.forename: John
authors.initials: J
authors.lastname: Yarnell
authors.forename: Philippe
authors.initials: P
authors.lastname: Amouyel
authors.forename: Dominique
authors.initials: D
authors.lastname: Arveiler
authors.forename: Frank
authors.initials: F
authors.lastname: Kee
authors.forename: Vanina
authors.initials: V
authors.lastname: Bongard
authors.forename: Jean
authors.initials: J
authors.lastname: Ferrières
mesh_terms: D000428:Alcohol Drinking / Q000453:epidemiology*; D000434:Alcoholic Beverages / Q000706:statistics & numerical data*; D003431:Cross-Cultural Comparison; D000431:Ethanol / Q000506:poisoning; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D009660:Northern Ireland / Q000453:epidemiology; D011446:Prospective Studies
chemical_list: D000431:Ethanol