Objectives To compare mortality and socioeconomic status among men invited to a health dialogue with men from all of Sweden approximately 24 years after the start of the study, and to analyse the associations between lifestyle and all-cause mortality, incidence of cardiovascular disease (CVD) and cancer. Design Longitudinal follow-up register study of men 33-42 years old at baseline. Setting Primary care in a community in Sweden. Subjects All 757 men aged 33-42 years old in a community in southern Sweden, and 652 of these men who participated in a health examination between 1985 and 1987. Interventions Health examination, lifestyle-directed health dialogue and group activities in primary care in cooperation with local associations. Primary and secondary outcome measures All-cause mortality, income and educational level, and associations between lifestyle at baseline and all-cause mortality, incidence of CVD and cancer. Results At follow-up, all-cause mortality was 29% lower (OR= 0.71, 95% CI 0.53 to 0.95) among all men invited to the health dialogue compared with all men from the same age cohort in all of Sweden (intention-to-treat) and 43% lower (OR= 0.57, 95% CI 0.40 to 0.81) among participating men (on-treatment). A healthy lifestyle was associated with lower mortality (OR= 0.16, 95% CI 0.07 to 0.36), with the strongest association for no smoking (OR= 0.38, 95% CI 0.21 to 0.68) and a healthy diet (OR= 0.37, 95% CI 0.20 to 0.68). A healthy lifestyle was also associated with a decreased incidence of CVD and cancer. There was a significantly higher proportion with short education among invited men compared with men from the same age cohort in all of Sweden. Conclusions This study indicates that a combination of low-risk and high-risk strategies, combining a health examination with a lifestyle-directed health dialogue conducted in an ordinary primary care setting in cooperation with local associations, may have contributed to reduced premature mortality. However, we cannot exclude that there may be other factors explaining the lower mortality.