Mexican women who experienced physical violence as adults were more likely to have clogged neck arteries, increasing the risk for stroke, researchers reported Thursday at the American Heart Association’s Epidemiology/Lifestyle 2016 Scientific Sessions.

Violence against women is a global problem, with a third of women worldwide experiencing physical or sexual violence during their lifetime, according to a 2015 United Nations report.

“Both society and the healthcare sector need to be aware of the importance of exposure to violence and its impact, not only on social well-being, but also on women’s long-term health,” Mario Flores, M.D., the study’s lead author and research assistant at the National Institute of Public Health in Mexico City, Mexico, said in a news release.

Compared to women who had not experienced physical violence in adulthood, victims of violence had an increased risk of narrowing in the carotid arteries, the main blood vessels that supply blood to the brain. This narrowing, detected with ultrasound imaging, can increase the risk of stroke.

Study participants included 634 healthy middle-aged women who were part of the Mexican Teachers’ Cohort. In 2012 and 2013, the women answered questions about having observed violence and experiencing physical or emotional neglect and physical or sexual violence.

“If you get into the mindset of an abusive relationship, part of what happens over time is the victims’ self-esteem is repeatedly diminished both through physical and psychological abuse,” said Aimee Israel, a clinical social worker who treats Hispanic men and women at Los Barrios Unidos clinic in Dallas. “The actions we might take as ordinary self-care don’t seem so ordinary to those who don’t see themselves as having value.”

For example, women exposed to violence have double the risk of depression, according to the World Health Organization.

“Having depression does put people at greater risk of physical disease regardless of culture,” Israel said. Other research shows depression may increase the risk of heart attacks and strokes.

Poverty, alcohol and drug abuse can also contribute to violence, Israel said.

“The fewer resources people have to deal with basic life stresses, the greater risk for physical violence,” she said.

Flores said more research is needed to determine how the findings could be applied in public health programs and medical practice.