Most of us are aware of the health risks of smoking, but a new study suggests this dangerous symptom of heart disease is common in smokers.

Smoking has long been associated with a variety of health issues. While this didn’t use to be the case, nowadays, teens and adults are well aware of the negative side effects of the habit, which has been linked with diseases like cancer, diabetes, lung diseases, and more.

A new study shows evidence that strokes might be one of the first signs of heart disease to present in smokers. Researchers also found that cardiovascular disease as the leading adverse health effect amongst smokers.

The study, published in the Journal of the American Heart Association, was conducted by researchers who wanted to raise awareness of the risk of cardiovascular disease when smoking is involved.

“There is often more awareness and concern about cancer as a result of smoking than heart disease, so we wanted to better define the risks of smoking-related to different types of cardiovascular disease and, most importantly, to cardiovascular death,” said lead author of the study, Sadiya S. Kahn, MD.

The research included data from over 106,165 adults in the U.S., between the ages of 29 and 79, free of cardiovascular disease at the start of the study. Participants were organized by smoking status and sex, with researchers finding a variety of results that were surprising in how strong the relationship is between smoking and cardiovascular disease.

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Some findings include middle-aged women who smoke being twice more likely than non-smokers to have a fatal cardiovascular disease event. In the case of men, smokers were 10% more likely to have long term risk for cardiovascular disease when compared to non-smokers. There was also evidence that suggests that younger smokers are more likely to develop cardiovascular disease than non-smokers, with risks increasing the longer people smoked.

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There’s a lot of evidence out there that indicates that smoking is bad for your health, especially if done over long periods of time. While smoking is addictive and difficult to quit, more and more evidence suggests that the sooner it’s done, the better outcomes your body will have, from lung health to heart health.