Chronic anxiety has been linked to depression and heart disease; in new, unrelated research, anxiety has been directly related to incidence of stroke.

Investigators tracked a nationally representative group of 6,019 people 25-74 years over a 22-year period. They found that people in the highest third of anxiety symptoms had a 33 percent higher stroke risk than those with the lowest levels.

“Everyone has some anxiety now and then. But when it’s elevated and/or chronic, it may have an effect on your vasculature years down the road,” said Maya Lambiase, Ph.D., study author and cardiovascular behavioral medicine researcher in the Department of Psychiatry at the University of Pittsburgh School of Medicine, in Pittsburgh, Pennsylvania.

People with high anxiety levels are more likely to smoke and be physically inactive, possibly explaining part of the anxiety-stroke link. Higher stress hormone levels, heart rate or blood pressure could also be factors, Lambiase said.

The research was published in the American Heart Association journal Stroke.