Belfast Prime Study


The Belfast PRIME study was set up by Professor Alun Evans to identify the reasons for the high levels of heart disease in men in Northern Ireland. Between 1991 and 1994 a group of 2750 men in Northern Ireland aged between 50 and 60 years was recruited. The men provided detailed information on their health, diet, physical activity, smoking behaviour and alcohol consumption. They had a baseline examination which included measurements of their height, weight, blood pressure, lung function and an ECG. Since the initial examination the development of heart disease and stroke in this group of men has been closely monitored.

The men in PRIME have been contacted at regular intervals and any changes in their medical history noted. The study is located at the RVH in close proximity to the Regional Medical Cardiology Centre which provides treatment for the majority of those in PRIME who have developed heart problems. This allows ready access to the case records, which are used to classify the heart disease which has developed. Most such studies have stopped after 10 years, however, international experts have suggested that there are good scientific reasons for prolonged (20-year) follow-up in studies of heart disease and stroke such as PRIME.

The steady reduction in the early onset of heart disease in recent years, due to improvements in public health and better focus on prevention, mean that the effects of atherosclerosis are presenting ever later in life resulting in the need for longer follow-up.  PRIME is ideally placed because the stability of the local population and the willingness of the men to co-operate have resulted in excellent levels of compliance. After 10 years 280 of the men had developed coronary heart disease. At this interim stage of the second 10-year cycle a further 150 men have been confirmed with heart disease. We continue to maintain high response rates to contacts made with the participants and are confident that we can deliver on the target of 20 years of follow-up in the PRIME study.

There have been a wide range of findings from the follow-up of the men in this longitudinal study.

The PRIME study has shown that:

  • In relation to alcohol consumption ‘binge’ drinking which concentrates alcohol intake on the weekend in Belfast cancels most of the heart-protective effects of alcohol found in other countries.
  • Inflammation has a significant role in the progression of coronary heart disease. It has identified novel inflammatory ‘biomarkers’ which independently predict the risk of coronary heart disease.
  • A score derived from a combination of ‘biomarkers’ improves risk estimation for events such as heart attacks.
  • Depression is related to coronary heart disease after adjustment for certain biomarkers. 

In conclusion, PRIME is a unique study, based in Northern Ireland, investigating various aspects of atherosclerotic disease. The study has resulted in over 75 research papers in major peer-reviewed journals. The output from PRIME is widely recognized as making a major contribution to the understanding of risk factors underpinning the development, progression and indeed prevention of cardiovascular disease.