A new study shows a pair of New Zealand earthquakes in 2010 and 2011 affected the cardiovascular health of residents long after the tremors subsided.

Middle-aged and older residents in the hardest-hit areas suffered 25 percent more cardiovascular-related deaths in the year after the Canterbury earthquakes when compared to neighbors in lesser-impacted areas. Residents of areas with the most property damage were also 22 percent more likely to suffer heart attacks than their neighbors, according to the study in The Lancet Planetary Health.

“A lot of people in my community were dealing with long-term stress and quite a long period of chronic stress,” senior study author Vicky Cameron, a professor of medicine at the University of Otago in Christchurch, New Zealand, told Reuters. “Our study suggests it’s not just the shaking people experience, but the long-term impacts on their lives, if they lose their homes.”

The study found no evidence of increased cardiovascular disease after one year.

Reuters cited a previous study finding hospitalization rates for heart attacks in New Orleans tripled in the six years after Hurricane Katrina. Environmental stressors play a role in the cardiovascular impact after these events, a UCLA cardiologist told the news agency.

“They end up smoking to deal with stress, don’t take their medications as well, have worse blood pressure and that’s why we see an association between natural disasters and long-term increases in cardiovascular disease,” Boback Ziaeian, MD, said.

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