Findings

Among 57 361 male smokers with no previous disease, the estimated 20-year risks of death at ages 35—54 years were 16% (95% CI 15—17) for those who reported consuming less than a bottle of vodka per week at baseline, 20% (18—22) for those consuming 1—2·9 bottles per week, and 35% (31—39) for those consuming three or more bottles per week; trend p<0·0001. The corresponding risks of death at ages 55—74 years were 50% (48—52) for those who reported consuming less than a bottle of vodka per week at baseline, 54% (51—57) for those consuming 1—2·9 bottles per week, and 64% (59—69) for those consuming three or more bottles per week; trend p<0·0001. In both age ranges most of the excess mortality in heavier drinkers was from external causes or the eight disease groupings strongly associated with alcohol in the retrospective enquiries. Self-reported drinking fluctuated; of the men who reported drinking three or more bottles of vodka per week who were reinterviewed a few years later, about half (185 of 321) then reported drinking less than one bottle per week. Such fluctuations must have substantially attenuated the apparent hazards of heavy drinking in this study, yet self-reported vodka use at baseline still strongly predicted risk. Among male non-smokers and among females, self-reported heavy drinking was uncommon, but seemed to involve similar absolute excess risks.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62247-3/abstract