The study included 3,200 people who originally came to Emory University health centers for a test to screen for heart disease. Among younger women, 58% with moderate to severe depression had heart disease, compared to 38% with mild or no depression. And younger women with moderate to severe depression had more than twice the odds of having major heart surgery or heart attack in the next five years. “Pre-menopausal women have a certain well-recognized hormonal cardioprotection, as long as they’re still having menstruation and ovulation cycles,” says lead study author Amit Shah, MD, of Emory University. “We think that depression can actually interfere with normal ovulation cycles, which could explain the increased heart disease risk among young depressed women.” Research Shah’s team published earlier this year compared young women who have had heart attacks to similarly aged male heart attack survivors. The only difference between the men and women, they found, was that women had a much stronger physical response to stress, according to brain scans. And too much stress can increase risk factors for heart disease like high blood pressure, Shah says. If you struggle with depression, what can you do? First, take it seriously. “Treat is as seriously as you would other heart disease risk factors like diabetes or smoking,” Shah says. In other words: see your doctor. As for what you can do on your own, Shah suggests exercise and stress reduction. “I think that focusing on holistic things like exercise and stress reduction techniques like meditation are potentially a win-win in terms of how you can affect both health and depression. Stress reduction and exercise have been shown to relieve depression symptoms and reduce heart disease risk.” MORE: What The Recent Coverage Of Antidepressants And Heart Disease Got So Wrong