The image of the vodka-swilling, chapka-clad Russian is a long-held stereotype. But there is a more serious side to the caricature.
The nation's much-loved tipple is a major cause of early death in Russia and has a direct impact on mortality rates in men, new research shows.
The study, published in medical journal The Lancet, says 25 per cent of Russian men die before they are 55 and that most of these deaths are attributable to alcohol consumption. This figure compares to 7 per cent in the UK and less than 1 per cent in the United States.
Over the past 30 years, there has been a positive correlation between the easier availability of vodka and premature death statistics, say scientists.
The study shows that Russian men who drink three or more bottles of vodka a week are 35 per cent more likely to go to an early grave than those who consume less than one.
"Russian death rates have fluctuated wildly over the past 30 years as alcohol restrictions and social stability varied under Presidents Gorbachev, Yeltsin and Putin, and the main thing driving these wild fluctuations in death was vodka," said study co-author Professor Sir Richard Peto, from Oxford University.
"This has been shown in retrospective studies, and now we've confirmed it in a big, reliable prospective study."
Researchers from the Russian Cancer Centre in Moscow, Oxford University in the UK and the World Health Organization International Agency for Research on Cancer, in France, tracked about 151,000 adult men in the Russian cities of Barnaul, Byisk and Tomsk from 1999 to 2010.
They interviewed them about their drinking habits and, when 8,000 of these men later died, followed up to monitor their causes of death.
Excess deaths among heavy drinkers were linked to alcohol poisoning, accidents, violence, suicide, and specific diseases such as throat and liver cancer, tuberculosis, pneumonia and pancreatitis.
Co-author Dr Paul Brennan, from the World Health Organisation International Agency for Research on Cancer in Lyon, France, said: "Because some who said they were light drinkers later became heavy drinkers, and vice versa, the differences in mortality that we observed must substantially under-estimate the real hazards of persistent heavy drinking."
Commenting on the research in The Lancet, Canadian expert Dr Jurgen Rehm, from the Centre for Addiction and Mental Health in Toronto, said binge-drinking was a major cause of the alcohol-related deaths.
"It is the combination of high overall volume with the specific pattern of episodic binges that is necessary to explain the high level and fluctuating trends of total and alcohol-attributed mortality in Russia," he said.
Christopher Allen, senior cardiac nurse at the British Heart Foundation, said: "This study graphically highlights the toll that heavy drinking has wreaked on communities in Russia. With the Winter Olympics fast approaching, it's a timely reminder of what we already know about drinking too much alcohol - it not only raises your risk of heart and circulatory disease, but also your risk of liver disease and some cancers."
Additional reporting by Press Association