Seniors with no history of heart disease have a strikingly high risk of dangerous heart problems soon after experiencing their first stroke, according to a new study.

The research involved participants over age 66 with no signs of heart disease. Once these men and women had their first ischemic stroke, their risk of suffering a major heart incident 30 days later was 25 times higher in women and 23 times higher in men than in their peers who hadn’t had a stroke. Heart events included heart attack, heart failure or cardiovascular death, reported Luciano Sposato, from Western University, Canada.

One year later, the relative risk of major cardiac events remained twice as high for these men and women.

Stroke is known to be linked to cardiovascular complications, so these findings in people with no apparent heart disease suggest that other mechanisms may be involved, said Sposato. He speculated that neurological health played a role in the outcomes, as the heart and brain share deep connections.

Clinicians should “very actively” watch for coronary symptoms or hidden heart disease in people who have recently had strokes to help prevent future cardiac events, he concluded.