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. 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.

Do lifestyle behaviours explain socioeconomic differences in all-cause mortality, and fatal and non-fatal cardiovascular events? Evidence from middle aged men in France and Northern Ireland in the PRIME Study

“…This is in agreement with previous work, which found smoking to be the strongest contributor, with physical activity and dietary pattern, but not alcohol consumption, making modest contributions (Marmot et al, 2008). As drinking patterns differ in France and NI, and these patterns are associated with CHD risk (Ruidavets et al, 2010), our analysis incorporated both alcohol consumption and the number of days over which alcohol was consumed.…”

“…This is in agreement with previous work, which found smoking to be the strongest contributor, with physical activity and dietary pattern, but not alcohol consumption, making modest contributions (Marmot et al, 2008). As drinking patterns differ in France and NI, and these patterns are associated with CHD risk (Ruidavets et al, 2010), our analysis incorporated both alcohol consumption and the number of days over which alcohol was consumed.Strengths of the current analysis are that we were able to consider a panel of lifestyle behaviours, including lifetime smoking behaviour, and that we included both an estimate of total alcohol intake and frequency of consumption. The analysis has been carried out in two countries with significant differences in lifestyle behaviours, but the observations made were similar in both countries.…”

“…Men aged 50-59 years from the general population were recruited between 1991 and 1993 in Lille, Strasbourg and Toulouse in France, and in Belfast, NI (Yarnell et al, 2005(Yarnell et al, , 2011. A detailed medical and lifestyle questionnaire was completed at the baseline examination, including lifetime Preventive Medicine 54 (2012) [247][248][249][250][251][252][253] smoking, physical activity (Wagner et al, 2003) alcohol consumption, (Ruidavets et al, 2010) and diet (Dauchet et al, 2004).…”

Wine and heart health: learning from the French paradox

“…(20) Comparing France with Northern Ireland, the typical drinking pattern in middle aged men in France of regular and moderate alcohol intake throughout the week, was associated with a low risk of ischaemic heart disease, whereas the binge drinking pattern more prevalent in Belfast conferred a higher risk. Only wine drinking and not that of beer or spirits was associated with a lower risk of hard coronary events, irrespective of the country.…”

Commentary on Kerr et al. (2013): The ‘French Paradox’ versus binge drinking

“…Conversely, binge drinking is certainly associated with harmful middle and long-term outcomes such as increased risk of cardiovascular disease [16,17] and obesity [18], not to mention the obvious short-term dangers. There may be a disturbing trend towards binge drinking, particularly involving spirits, in younger European adults and, as stated by Kerr et al in their conclusion, in the United States as well.…”