Middle-age men who were anxious or depressed teens are at increased risk for heart attack, according to a study that included more than 238,000 men born between 1952 and 1956 who underwent extensive exams when they were 18 or 19 years old and were followed to age 58.

Men diagnosed with anxiety or depression in their late teens had a 20 percent higher risk of heart attack than those who didn’t.

The takeaway: “Be vigilant and look for signs of stress, depression or anxiety that is beyond the normal teenage angst: Seek help if there seems to be a persistent problem,” suggested study author Cecilia Bergh, a senior lecturer in health sciences at Orebro University in Sweden.

“If a healthy lifestyle is encouraged as early as possible in childhood and adolescence it is more likely to persist into adulthood and improve long-term health.”