Worrywarts aren’t doing so well when it comes to their heart health, suggests a new study published Friday in the BMJ Open.

Researchers analyzed data from a nationwide cardiovascular research project conducted in Norway. They looked at over 7,000 Norwegians free of heart disease prior to the study and tracked their heart health over the next 12 years, while singling out the 700 or so volunteers who reported a high degree of health anxiety — defined as a preoccupation with having or developing in the near future a serious health problem despite not being physically ill.

While only 6 percent of people with high health anxiety were diagnosed with coronary artery disease past the first year of study, that was about double the rate of the general population. Even after accounting for other known risk factors, people with health anxiety were still 70 percent more likely to someday have heart disease than non-worrywarts. And the higher the level of health anxiety, the greater the risk, adding more support to a direct link.

“This finding corroborates and extends the understanding of anxiety in various forms as a risk factor for [coronary artery disease],” the authors concluded.

Research elsewhere has shown that anxiety disorders in general can help trigger or worsen cardiovascular disease, right alongside diet, a sedentary lifestyle, and exercise. But relatively little if no research has specifically looked at health anxiety, the authors said.

While health anxiety alone may increase our heart disease risk, it’s possible it can indirectly do so too. People with health anxiety were also more likely to smoke and spend less time exercising. Maybe, the researchers speculated, the added stress leads them to seek out sin sticks, while the fear of straining their presumingly frail bodies keeps them away from the gym.

Although the connection between health anxiety and heart health seems fairly strong, the research is less clear on what doctors and worried patients should do about it, especially since anxiety attacks can often look and feel just like a heart attack. And telling these particular patients to stay on guard for heart disease signs may only worsen their anxiety.

“These findings illustrate the dilemma for clinicians between reassuring the patient that current physical symptoms of anxiety do not represent heart disease,” the authors wrote, “contrasted against the emerging knowledge on how anxiety, over time, may be causally associated with increased risk of [heart disease].”

Perhaps the best solution might involve a compromise between doctors and patients, they added. Such that doctors encourage patients to seek treatment for their health-related anxiety while still reaffirming the role anxiety can play in their physical health.

Source: Berge L, Skogen J, Sulo G, et al. Health Anxiety And Risk Of Ischaemic Heart Disease: A Prospective Cohort Study Linking The Hordaland Health Study (Husk) With The Cardiovascular Diseases In Norway (Cvdnor) Project. BMJ Open. 2016.