Alcohol Type May Shape Long-Term Mortality Risk

Mortality risk varied by drink type in a study of 340,924 adults in the United Kingdom, with wine showing a different pattern from beer, cider and spirits at low to moderate intake.

Presented at the American College of Cardiology’s Annual Scientific Session (ACC.26), the research followed participants in the UK Biobank study from 2006 to 2022. Zhangling Chen, MD, PhD, a professor at the Second Xiangya Hospital, Central South University in China and the study’s senior author, said: “These results come from the general population, and in certain high-risk groups, such as people with chronic diseases or cardiovascular conditions, the risks could be even higher.”

At enrollment, participants completed a dietary questionnaire and were placed into one of four alcohol intake groups based on grams of pure alcohol consumed per day and per week. A 12 ounce beer, a 5 ounce glass of wine, and a 1.5 ounce serving of spirits each contain roughly 14 grams of pure alcohol. People who drank less than 20 g (about 1.5 standard drinks) per week were classified as never or occasional drinkers.

Men who consumed between 20 g per week and 20 g per day, and women who consumed between 20 g per week and 10 g per day, were put in the low alcohol group. Moderate intake was defined as 20 g to 40 g (about 1.5 to three standard drinks) per day for men and 10 g to 20 g per day for women. High intake meant more than 40 g (about three drinks) per day for men and more than 20 g (about 1.5 drinks) per day for women.

Participants were followed for an average of more than 13 years. Compared with never or occasional drinkers, high intake drinkers had a 24% higher risk of death from any cause, a 36% higher risk of death from cancer, and a 14% higher risk of death from heart disease.

At low and moderate intake levels, the results differed by beverage. Spirits, beer and cider were tied to a significantly higher risk of death, while similar levels of wine intake were linked to a significantly lower risk of death. For cardiovascular disease deaths specifically, moderate wine drinkers had a 21% lower risk of dying from cardiovascular disease than never or occasional drinkers.

By contrast, even low consumption of spirits, beer or cider was associated with a 9% higher risk of cardiovascular death compared with never or occasional drinking. Chen said, “Our findings help clarify previously mixed evidence on low to moderate alcohol consumption.”

He added: “These findings can help refine guidance, emphasizing that the health risks of alcohol depend not only on the amount of alcohol consumed, but also on the type of beverage. Even low to moderate intake of spirits, beer, or cider is linked to higher mortality, while low to moderate intake of wine may carry lower risk.”

Researchers said several factors may explain the differences by beverage type. Red wine contains compounds such as polyphenols and antioxidants, which may support cardiovascular health. Wine is also more often consumed with meals and by people who tend to have higher-quality diets and healthier overall habits.

Spirits, beer and cider are more often consumed outside meals and were linked with lower overall diet quality and other lifestyle risk factors. Chen said, “Taken together, these factors suggest that the type of alcohol, how it is consumed, and the associated lifestyle behaviors all contribute to the observed differences in mortality risk.”

The researchers adjusted for demographic factors, socioeconomic status, lifestyle factors, cardiometabolic factors, and family history of diabetes, cardiovascular disease and cancer. They said the work remains observational, that high-quality randomized trials would be useful, and that drinking habits were self-reported at the start of the study.

The analysis did not capture changes in alcohol consumption over time, and UK Biobank participants tend to be healthier than the broader population, which may limit how widely the findings apply. Even so, the large number of participants and long follow-up period give the study substantial statistical strength, and the researchers said it offers a more detailed view of alcohol’s health effects than many earlier studies.

Meeting: American College of Cardiology’s Annual Scientific Session