Young adults who feel down or depressed are more likely to develop cardiovascular disease and have poor heart health, according to a new study led by Johns Hopkins Medicine researchers, who analyzed data from more than a half million people between the ages of 18 and 49.

The findings add to a growing body of evidence connecting cardiovascular disease with depression among young and middle-aged adults, and suggest the relationship between the two could begin in early adulthood.

The study also found that young adults who self-reported feeling depressed or having poor mental health days had higher rates of heart attacks, strokes and risk factors for heart disease compared with their peers without mental health issues. “When you’re stressed, anxious or depressed, you may feel overwhelmed, and your heart rate and blood pressure rise. It’s also common that feeling down could lead to making poor lifestyle choices like smoking, drinking alcohol, sleeping less and not being physically active — all adverse conditions that negatively impact your heart,” says cardiologist Garima Sharma, senior author of the study, which appeared in Journal of the American Heart Association.

“The relationship between depression and heart disease is a two-way street. Depression increases your risk of heart issues, and those with heart disease experience depression,” says Yaa Adoma Kwapong, a postdoctoral research fellow at Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease and lead author of the study.

“Our study suggests that we need to prioritize mental health among young adults and perhaps increase screening and monitoring for heart disease in people with mental health conditions and vice versa to improve overall heart health.”