Divorce is often a messy situation that weighs on both combatants — I mean, former partners. A recent study conducted at Duke Clinical Research Institute has found that the stress of a divorce can increase a person’s risk for a heart attack, even among women who have gone on to remarry. In fact, women who have dealt with the pressure of two or more divorces are almost twice as likely to suffer a heart attack compared to women who have been happily married to the same person.

“Divorce is a major stressor, and we have long known that people who are divorced suffer more health consequences,” Dr. Matthew Dupre, associate professor of medicine at Duke University, said in a statement. “But this is one of the first studies to look at the cumulative effect of divorce over a long period. We found that it can have a lasting imprint on people’s health.”

Dupre and his colleagues gathered data using a nationally representative group of 15,827 people between the ages of 45 and 80. Researchers conducted interviews every two years from 1992 to 2010 regarding their marital status and health. Participants had been married at least once while one-third of the group had been divorced at least once over the course of the 18-year study.

Although men who had been divorced stood the same risk for a heart attack as married men, women who dealt with one divorce had a significantly higher risk compared to women who remain married to the same spouse. Heart attack risk for men only increased after two or more divorces. However, even if a woman remarries, her risk for a heart attack remains elevated, while a man who remarries experiences the same risk for a heart attack as a man who has remained married to the same partner.

“Earlier studies have suggested that marital loss has a greater impact on the health of women than men,” Dupre told Reuters Health in an email. “The reasons for these differences are not entirely known; however, the prevailing view is that divorced women suffer greater economic losses and emotional distress than divorced men. Men are also much more likely to remarry after divorce than women, and among those who remarry, men remarry sooner than women.”

A similar study published in Health Psychology revealed that people who lose sleep over a divorce often have high blood pressure. Out of 138 people who had been divorced or separated, those who experienced problems with sleeping up to around 10 weeks after the divorce or separation experienced a spike in blood pressure over time.

Source: Peterson E, Liu G, George L, Dupre M. Association Between Divorce and Risks for Acute Myocardial Infarction. Circulation: Cardiovascular Quality and Outcomes. 2015.