Young and middle-aged women who consume more than one drink a day or eight or more alcoholic drinks a week; are significantly more likely to develop coronary heart disease than those who drink less, according to a study to be presented at the American College of Cardiology’s annual scientific meeting in Atlanta.

The risk is higher in both men and women who reported heavy drinking, but the link between alcohol and heart disease appears to be particularly strong in women, according to the findings.

The study focused on adults aged 18 to 65 and the researchers used data from more than 430,000 people who received medical care at the American health organization “Kaiser Permanente Northern California.” The participants were an average of 44 years old and had no heart disease at the start of the study. The researchers analyzed the relationship between the level of alcohol consumption participants reported in 2014-2015 and coronary heart disease diagnoses over the following four years.

Based on the self-report estimates, the researchers categorized the participants’ total alcohol consumption as low (one to two drinks per week), moderate (three to 14 drinks per week for men and three to seven drinks per week for women) or high (15 or more drinks per week for men and eight or more drinks per week for women). They also categorized participants according to whether they had binged, meaning more than four drinks for men or more than three drinks for women in a single day during the past three months. Subjects who reported no alcohol use were excluded from the study. The researchers adjusted the data to take into account age, physical activity, smoking and other cardiovascular risk factors.

It was found that the incidence of coronary heart disease increased with higher levels of alcohol consumption. Among women, those who reported high alcohol consumption had a 45% higher risk of heart disease compared to those who reported low consumption and a 29% higher risk compared to those who reported moderate consumption. Men who drank heavily were 33% more likely to develop heart disease than men who drank moderately.

The difference was greatest among people in the heavy drinker category, as women in this category were 68% more likely to develop heart disease compared to women who reported moderate drinkers. In contrast, the results showed no significant difference in risk between subjects who reported moderate versus low alcohol consumption.

As noted, a limitation of the study is that people tend to underreport their alcohol intake, so the study likely provides conservative estimates of heart disease risk linked to alcohol consumption.