Heavy alcohol use has consistently been tied to poorer health, no matter what type of alcohol a person drinks. At lower levels of consumption, however, the health effects may differ depending on the beverage, according to research presented at the American College of Cardiology’s Annual Scientific Session (ACC.26).
The findings, based on data from more than 340,000 adults in Britain, support earlier evidence suggesting that lower alcohol consumption is generally better for health. They also offer a closer look at how low and moderate drinking may be associated with different outcomes depending on whether people consume wine, beer, cider or spirits.
“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,” said Zhangling Chen, MD, PhD, a professor at the Second Xiangya Hospital, Central South University in China and the study’s senior author.
Tracking Alcohol Intake and Mortality
Researchers examined drinking habits and mortality data from 340,924 adults who took part in the UK Biobank study between 2006 and 2022. Participants completed a dietary questionnaire when they entered the study, and researchers placed them into four groups according to how much pure alcohol they consumed each day and week.
For reference, a 12-ounce can of beer, a 5-ounce glass of wine, and a 1.5-ounce shot of spirits each contain about 14 grams of pure alcohol. People consuming less than 20 g (about 1.5 standard drinks) per week were classified as never or occasional drinkers. Men consuming between 20 g per week and 20 g per day and women consuming between 20 g per week and 10 g per day were considered to have low alcohol consumption.
Daily consumption of 20 g to 40 g (about 1.5 to three standard drinks) for men and 10 g to 20 g for women was considered moderate. Daily consumption of more than 40 g (about three drinks) for men and 20 g (about 1.5 drinks) for women was considered high. Researchers followed participants’ health outcomes for more than 13 years on average.
Heavy Drinking Linked to Higher Death Risk
Compared with people who never drank or drank only occasionally, those in the high consumption group were 24% more likely to die from any cause. They were also 36% more likely to die from cancer and 14% more likely to die from heart disease.
At low and moderate levels of drinking, a different pattern emerged depending on the type of alcohol consumed. Spirits, beer and cider were associated with a significantly greater risk of death, while similar levels of wine consumption were associated with a significantly lower risk.
The contrast was also seen in deaths from cardiovascular disease. Moderate wine drinkers had a 21% lower risk of dying from cardiovascular disease compared with never or occasional drinkers. In contrast, even low levels of spirits, beer or cider consumption were associated with a 9% higher risk of cardiovascular death compared with drinking never or occasionally.
“Our findings help clarify previously mixed evidence on low to moderate alcohol consumption,” Chen said. “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.”
Why Wine May Show a Different Pattern
Several factors could help explain why the results differed by beverage type, according to the researchers. Red wine contains compounds such as polyphenols and antioxidants, which may provide cardiovascular benefits.
Drinking habits and lifestyle may also play an important role. Wine is more often consumed with meals and tends to be favored by people with higher-quality diets and healthier behaviors overall. Spirits, beer and cider are more commonly consumed outside of meals and were associated with poorer overall diet quality and other lifestyle risk factors.
“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,” Chen said.
Important Limitations of the Study
The researchers adjusted their analysis for a wide range of factors, including demographics, socioeconomic status, lifestyle, cardiometabolic factors and family history of diabetes, cardiovascular disease and cancer.
Still, the study was observational, which means it cannot establish that a particular type of alcohol directly caused the differences in mortality risk. The researchers said high-quality randomized trials could help clarify the health effects of alcohol consumption.
Alcohol intake was also based on participants’ self-reported drinking habits at the beginning of the study, so the analysis did not account for changes in alcohol consumption over time. In addition, UK Biobank participants tend to be healthier than the population overall, which could limit how broadly the findings apply.
Despite those limitations, the large number of participants and the long follow-up period gave the study substantial statistical power. Researchers said the findings provide a more detailed and nuanced view of alcohol and health than many earlier studies by examining both the amount and type of alcohol consumed across several mortality outcomes.
