Even stroke survivors who don’t experience any immediate complications are still more likely to die or have a heart attack than people who never had a stroke, a recent Canadian study suggests.

For the study, researchers examined data on 26,366 adults in the province of Ontario who had a stroke or a mini-stroke and didn’t experience any complications for three months. Over the next five years, they compared how many of these patients died, had a heart attack or another stroke or were admitted to a long-term care facility to a control group of 263,660 people who never had a stroke, but were otherwise similar in characteristics like age, gender and income.

After one year, 9.5 percent of the survivors died or had serious complications, compared with 5.4 percent of people in the control group, researchers report in the Canadian Medical Association Journal. After five years, 36 percent of stroke survivors died or had these complications, compared to 21 percent in the control group.

“The current study focused specifically on determining long-term risk for survivors who were “stable” with no complications during the early highest-risk period right after a stroke,” said senior study author Dr. Richard Swartz, a neurologist at Sunnybrook Health Sciences Centre in Toronto.

“What was surprising was that, even those with no early complications after stroke were at twice the risk of adverse complications, with a 7-fold increased risk of recurrent stroke at one year, a risk that remained high for up to five years,” Swartz said by email.

The findings suggest that just like survivors of more serious strokes, these “low-risk” patients need ongoing screening and treatment to minimize the odds of problems down the line, Swartz said.

This might include taking blood thinners or medication to lower blood pressure or keep cholesterol levels in a healthy range, as well as lifestyle changes focused on a healthier diet, more exercise, less alcohol consumption and quitting smoking.