Belfast's binge drinking culture could be behind the country's high rates of heart disease, according to a paper published on bmj.com today.
The study, which compares drinking patterns of middle aged men in France and Belfast, finds that the volume of alcohol consumed over a week in both countries is almost identical. However, in Belfast alcohol tends to be drunk over one or two days rather than regularly throughout the week as in France.
The research also finds that the average amount of alcohol consumed in Belfast over the weekend is around 2-3 times higher than in France.
The link between alcohol consumption and heart disease and premature death has already been established says the paper. What remains unclear, argue the authors, is the role of drinking patterns and the type of alcohol consumed.
The researchers, led by Dr Jean-Bernard Ruidavets from Toulouse University, investigated whether drinking patterns in Northern Ireland and France were linked to the known disparity in heart disease between these two culturally diverse countries.
Over a ten year period, Ruidavets and colleagues assessed the alcohol consumption of 9,758 men from three centres in France (Lille, Strasbourg and Toulouse) and Belfast. The participants were free from heart disease when the research started in 1991 and were between the ages of 50 to 59.
The participants were divided into never drinkers, former drinkers, regular drinkers and binge drinkers. The 'drinkers' were asked via interviews and questionnaires about the volume of alcohol they consumed on a weekly and daily basis and also about the type of beverage. Cardiovascular risk factors, such as age, tobacco use, level of physical activity, blood pressure, and waist circumference were also taken into account.
The results show that the men who "binge" drink had nearly twice the risk of heart attack or death from heart disease compared to regular drinkers over the 10 years of follow up.
In the study, binge drinking is defined as excessive alcohol consumption (over 50g) drunk over a short period of time, for example on one day during the weekend (50g of alcohol equates to 4-5 drinks, and a drink to 125ml of wine or a half pint of beer).
The researchers write: "We found that alcohol consumption patterns differed radically in the two countries: in Belfast most men's alcohol intake was concentrated on one day of the weekend (Saturday), whereas in the three French centres studied alcohol consumption was spread more evenly throughout the entire week." They add: "the prevalence of binge drinking, which doubled the risk of ischaemic heart disease compared with regular drinking, was almost 20 times higher in Belfast than in the French centres."
Another reason for the higher risk of heart disease in Belfast, say the authors, could be that more people tend to drink beer and spirits than wine. In France, wine is the main alcoholic drink of choice and established research has concluded that drinking a moderate about of wine can protect against heart disease.
Ruidavets and colleagues conclude that the research has important public health implications, especially given that binge drinking is on the rise amongst younger people in Mediterranean countries. They say: "The alcohol industry takes every opportunity to imbue alcohol consumption with the positive image, emphasising its beneficial effects on ischaemic heart disease risk, but people also need to be informed about the health consequences of heavy drinking."
In an accompanying editorial, Annie Britton from University College London says binge drinking does not just increase the risk of heart disease but is also linked to other health problems such as cirrhosis of the liver and several kinds of cancer. It causes problems to society too.
She says public health messages aimed at middle aged men should stress that the protective effects of alcohol may not apply to them if they binge drink and they could be putting themselves at a higher risk of having a heart attack. When it comes to young people, Britton argues that they "are unlikely to take much notice of the findings about patterns of alcohol consumption and risk of heart disease, at a time when their risk of heart disease is low ... they are more likely to respond to anti-binge drinking messages that focus on the risk of alcohol poisoning, injuries, assaults, and regretful risky sexual encounters."