Building minimal bootable to be very small is possible, but is difficult in comparison to an apt install - I imagine for the most part porting docker container configs to a bootable OS might be the best approach for small-medium projects.
The problem with this approach is that you can make it as small as you want but it's still Linux. At a certain point are you going to start patching things out like support for users? Support for management of multiple processes? There's a non-trivial set of syscalls and data structures designed solely for these constructs. You can't just seccomp it and call it a day.
For us it's not about the size (that's nice of course) but it's more about the performance and security.
I'm not suggesting it's a good idea, but it's there. I'm sure there's more minimal, and less minimal options available.
I don't think there's any security impacts with using alpine Linux specifically, aside from default credentials in a bunch of containers a few months back.