Three decades of follow-up suggest that alcohol and beverage type may relate differently to longevity and heart attack risk, but, say the researchers, the observational findings do not prove that drinking itself is protective or harmful, reports News-Medical.
In their study published in the Scandinavian Journal of Primary Health Care, the researchers, from the University of Gothenburg, Sweden, evaluated the associations of alcohol consumption and beverage type with myocardial infarction (MI), stroke, and all-cause mortality among middle-aged Swedish male automotive workers who were followed for 30 years.
Leading cause
Cardiovascular disease remains a leading cause of death even as Swedish men’s life expectancy increased by about two years between 2001–2010 and 2011–2020. Alcohol’s relationship with cardiovascular health is complex: research has described a J-shaped pattern, while concerns include the “sick quitter” hypothesis and evidence that even low intake can adversely affect health. Findings also vary by region and beverage type.
Alcohol has been associated with MI in some studies, whereas other research has emphasised drinking frequency or reported possible effects of beer or wine. International guidance states that no level of alcohol consumption is risk-free, underscoring the need for further research.
About the study
The prospective longitudinal analysis used data from the Coeur study, initiated in 1993 among 1 144 men aged 45-50 employed at Volvo in Gothenburg, Sweden. After exclusions for refusal, illness, cardiovascular treatment, one outlier in alcohol consumption, and 26 participants with missing data, 973 men were included.
Baseline information included alcohol use, blood pressure, laboratory tests, smoking, exercise, diabetes, occupational status, and household status. A 1995 sub-study provided 173 blood samples and 84 questionnaires for additional analyses.
Total alcohol intake was calculated from self-reported drinks per week and estimated pure alcohol per beverage: 6g for beer, 14g for wine, and 13g for hard liquor. Participants were categorised by total intake, beverage type, ranked consumption groups, and risk consumption of at least 120 g/week.
Outcomes were all-cause mortality, MI and stroke, identified through national health registers through 31 December 2023, using International Classification of Diseases (ICD) codes. Descriptive data used medians and interquartile ranges (IQRs); statistical analyses used odds ratios (ORs), Spearman’s rho, Kaplan-Meier estimates, chi-square tests, and Cox regression in the Statistical Package for the Social Sciences (SPSS).
Cox regression models were adjusted for relevant cardiovascular and socioeconomic factors, with the covariates varying by outcome. Some beverage-specific models were also adjusted for consumption of another beverage type.
Interesting outcomes
Among 973 participants, 237 (24%) died, 100 (10%) experienced MI, and 89 (9%) experienced strokes. Alcohol drinkers had a median intake of 56 g/week versus 0 g/week among non-drinkers.
Alcohol and wine drinkers had slightly higher high-density lipoprotein cholesterol levels than non-drinkers. Drinking groups also contained higher proportions of clerical workers and married or cohabiting participants. Single, divorced, or widowed workers had nearly twice the mortality rate of married or cohabiting workers, while manual workers had almost 59% higher mortality than clerical workers.
Spearman’s rho analysis showed positive correlations between high-density lipoprotein cholesterol and total alcohol, wine, and beer intake. No correlation was found between self-reported alcohol use and gamma-glutamyl transferase in the 1995 sub-cohort; however, self-reported total alcohol intake correlated moderately with the 1995 diet-study assessment (R = 0.58).
Crude all-cause mortality was lower among alcohol drinkers, who had substantially lower mortality odds than non-drinkers. Wine and beer consumption showed similar patterns, while several ranked total-alcohol consumption groups also had lower odds than abstainers.
The risk-drinking group, however, did not differ significantly from the non-risk group.
For MI, the direct comparison between alcohol drinkers and non-drinkers was not significant. However, the second-lowest total-alcohol consumption group had about twice the odds of MI compared with non-drinkers.
Beer consumption was associated with MI: 76 beer drinkers (12%) versus 24 non-beer drinkers (7%) experienced events, corresponding to about 70% higher odds of MI among beer drinkers. The highest beer-consumption group also had significantly higher odds of MI than non-beer drinkers. Wine consumption was not significantly associated with MI in the 30-year cohort.
No significant association was found between alcohol consumption and stroke, with event rates similar among drinkers and non-drinkers.
Adjusted Cox regression indicated a small association between total alcohol intake and all-cause mortality after accounting for relevant cardiovascular and socioeconomic factors. The corresponding adjusted association for wine was not statistically supported.
For MI, the adjusted model also indicated a small association with beer consumption. Adjusted analyses for stroke showed no significant associations with total alcohol, beer, or wine.
Kaplan-Meier analysis showed a longer estimated mean time to death during follow-up among alcohol drinkers than non-drinkers: 28.1 versus 26.8 years, a difference of 1.3 years.
Wine drinkers had an estimated mean time to death of 28.5 years versus 27.1 years among non-wine drinkers, while the corresponding estimates were 28.1 and 27.1 years for beer drinkers and non-beer drinkers, respectively.
For MI, beer drinkers experienced the event at a mean of 28.5 years, compared with 29.1 years among non-beer drinkers, a difference of 0.6 years. Stroke differences were not significant across beverage groups.
Conclusions
After 30 years of follow-up, alcohol consumption among these middle-aged Swedish male automotive workers was associated with a longer estimated time to death during follow-up and lower odds of all-cause mortality, while beer consumption was associated with a higher likelihood of MI and an earlier MI event. No significant association was observed between alcohol consumption and stroke.
The findings require cautious interpretation because the cohort consisted of middle-aged Swedish men with stable employment, alcohol exposure was based on self-reporting, high-risk drinkers were underrepresented, and lifestyle factors could change during follow-up.
Drinking groups also differed substantially in socioeconomic characteristics, and unmeasured factors such as diet and cultural context could have contributed to the observed associations. The study therefore cannot establish that alcohol itself improved survival or that beer directly increased MI risk.
Larger and more diverse studies with detailed drinking and lifestyle assessments are needed.
Study details
Link between alcohol consumption and myocardial infarction, stroke, and all-cause mortality among Swedish male automotive workers over 30 years
Hanna Asp & Lennart Dimberg
Published in Scandinavian Journal of Primary Health on 7 August 2026
Introduction
The relationship between alcohol consumption and the incidence of myocardial infarction (MI), stroke and all-cause mortality exhibits significant regional variation.
Objective
This prospective study aimed to investigate this association analysing data from a cohort of Swedish men aged 45–50 years at baseline, evaluating subgroups over various time intervals, and compiling data on cardiovascular endpoints.
Methods
The Coeur study, conducted between 1993 and 1995, included 973 middle-aged male employees out of a randomly selected sample of 1144 individuals from a Swedish automotive company. Participants were followed for 30 years using national health registers. The accumulated incidence of first-time stroke, first-time MI and all-cause mortality was calculated and adjusted for cardiovascular risk factors. Data analysis employed time-to-event methods (Kaplan–Meier’s estimates and hazard ratios) and measures of association (odds ratios and correlation analysis).
Results
No statistically significant association was observed between alcohol consumption and stroke (p > 0.05). However, alcohol consumption was associated with lower odds of MI (OR = 0.57, 95% CI: 0.41–0.79) and a slight increase in survival time (HR = 0.997, 95% CI: 0.995–1.000). Alcohol consumers had a median survival advantage of 1.3 years compared to non-consumers. All beverage types showed a negative association with all-cause mortality (total alcohol: OR = 0.57; beer: OR = 0.68, 95% CI: 0.50–0.92; wine: OR = 0.55, 95% CI: 0.41–0.75). Conversely, beer consumption was linked to higher odds of MI (OR = 1.70, 95% CI: 1.05–2.75).
Conclusions
While alcohol consumption in middle-aged men after 30 years follow-up is associated with increased survival time, beer correlates with a higher likelihood of MI.
See more from MedicalBrief archives:
Eat, drink and be merry to avoid heart attacks – Chinese study
Beer, spirits detrimental to visceral fat and heart, but not wine – US study
No amount of alcohol is good for the heart – World Heart Federation
Moderate alcohol use associated with lower CVD risk and all-cause mortality – ASPREE