A new study suggests that a drop in your income is bad for more than just your pocketbook: It can be bad for your heart.

The study, published in Circulation, the journal of the American Heart Association, shows how ups and downs in your income early in life can lead to cardiovascular disease and even premature death later on.

A big economic hit (losing $20,000 or more) has an even greater impact, as Reuters notes. Individuals who experienced at least one pay drop of that size were almost four times more likely to develop cardiovascular disease and nearly two and a half times more likely to die prematurely than those whose income did not change.

Researchers found that individuals with multiple drops in income early in life were two and a half times more likely to develop heart disease—and 92% more likely to die prematurely than those who had stable paychecks.

The correlations between income and cardiovascular events were so conclusive that even the researchers were surprised. “We assumed that income drops or frequent changes in income were probably not good for health, considering that these are thought of as stressful events.” said Tali Elfassy, an assistant professor epidemiology at the University of Miami and co-author of the study, to Time. “But we were surprised by the magnitude of the effect we saw.”

Such income setbacks, unfortunately, are all too common. The National Endowment for Financial Education recently published research showing that about 96% of American men experience four or more income shocks—defined as a period in which your earnings drop by 10% or more from one year to the next—by the time they turn 70.

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