A study of more than 340,000 adults suggests that not all alcoholic drinks carry the same health risks, especially at low to moderate levels. Researchers say both how much and what you drink may shape your long-term risk of death.
How much you drink has long been known to matter for your health. New research suggests what you drink may matter, too.
In one of the largest studies of its kind, researchers analyzing data from more than 340,000 British adults found that heavy drinking raised the risk of death regardless of whether people favored wine, beer, cider or spirits. But at low to moderate levels, the type of alcohol people chose was linked to sharply different outcomes.
The study, which will be presented at the American College of Cardiology’s Annual Scientific Session (ACC.26), adds nuance to a growing body of evidence that less alcohol is generally better for long-term health.
Researchers drew on the UK Biobank, a large health database that has followed hundreds of thousands of adults since the mid-2000s. Participants in this analysis enrolled between 2006 and 2022 and reported their usual drinking habits in a detailed dietary questionnaire.
The team grouped people into four categories based on how many grams of pure alcohol they consumed, on average, per day and per week. For context, a typical 12-ounce beer, 5-ounce glass of wine or 1.5-ounce shot of spirits each contains about 14 grams of pure alcohol.
People who consumed less than 20 grams per week — roughly one-and-a-half standard drinks spread over a week — were classified as never or occasional drinkers. Above that, men and women were placed into low, moderate or high consumption categories using different cutoffs that reflected sex-based differences in how bodies process alcohol. Health outcomes were then tracked for more than 13 years on average.
Compared with never or occasional drinkers, people in the high-consumption group were substantially more likely to die during the follow-up period. High 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.
The picture became more complicated at lower levels of drinking.
When researchers looked at low and moderate drinkers, they found that people who mainly drank spirits, beer or cider had a significantly higher risk of death than never or occasional drinkers. In contrast, people who drank similar amounts of wine had a significantly lower risk of death.
For cardiovascular disease specifically, moderate wine drinkers had a 21% lower risk of dying from heart and blood vessel conditions compared with never or occasional drinkers. Even low intake of spirits, beer or cider, however, was linked to a 9% higher risk of cardiovascular death than drinking never or only occasionally.
Study leaders say the results help make sense of years of conflicting headlines about whether small amounts of alcohol might be protective or harmful.
“Our findings help clarify previously mixed evidence on low to moderate alcohol consumption,” senior author Zhangling Chen, a professor at the Second Xiangya Hospital, Central South University in China, said in a news release.
Chen emphasized that the numbers come from generally healthy adults and may underestimate the danger for some people.
“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,” he said.
The study cannot prove that wine itself directly protects the heart or that beer, cider and spirits directly cause harm. But the researchers point to several reasons why different drinks might be associated with different outcomes.
Red wine contains polyphenols and antioxidants, plant-based compounds that have been studied for potential benefits to blood vessels and cholesterol. Wine is also more often consumed with meals and is more common among people who report higher-quality diets and other healthy behaviors.
In contrast, spirits, beer and cider were more often consumed outside of meals and were linked in this study to lower overall diet quality and more lifestyle risk factors, such as smoking or lower levels of physical activity.
“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 added.
To tease apart these influences, the researchers adjusted their analyses for a wide range of factors, including age, sex, socioeconomic status, lifestyle habits, cardiometabolic measures and family history of diabetes, cardiovascular disease and cancer. Even after these adjustments, the patterns by beverage type and amount remained.
Still, the team cautions that the study has important limitations. It is observational, meaning it can reveal associations but cannot definitively show cause and effect. Alcohol intake was self-reported at the start of the study and did not capture changes in drinking patterns over time. And UK Biobank participants tend to be healthier than the general population, which may limit how broadly the findings apply.
Chen and colleagues say that despite these caveats, the large sample size, long follow-up and detailed breakdown by drink type and dose provide a more granular picture than many earlier reports.
“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,” added Chen.
The work, titled “Alcohol Use at Mid-Life and All-Cause and Cause-Specific Mortality,” will be presented by researcher Ziyue Li on March 28 at ACC.26 n New Orleans, which brings together cardiologists and cardiovascular specialists from around the world to discuss the latest in prevention and treatment.
For students, young adults and anyone rethinking their relationship with alcohol, the message is not that wine is a health food or that drinking is necessary for heart health. Public health experts continue to stress that people who do not drink should not start for potential medical benefits, and that those who do drink should stay within recommended limits or consider cutting back.
What this study adds is a more detailed map of the trade-offs: heavy drinking clearly raises the risk of dying from cancer, heart disease and other causes, and even light drinking appears riskier with some beverages than others.
Future randomized trials and more diverse population studies will be needed to understand whether specific components of wine, drinking with meals, or broader lifestyle patterns drive the differences seen here. For now, the findings give clinicians and patients more information to have honest conversations about alcohol, health and the choices people make at midlife that can shape their risk for decades to come.
Source: American College of Cardiology