Patients who are depressed or who continue smoking after a heart attack often continue to have chest pain one year later and are more likely to have another heart attack or die, Reuters reported Monday.

Researchers from Denver Veterans Affairs Medical Center studied questionnaires from more than 1,900 people one year after they suffered heart attacks between 2003 and 2004 and found that nearly one in five people still had angina.

Dr. Thomas Maddox, who led the study, said one of the strongest associations with chest pain was depression.

“Ideal care after (heart attack for these patients may require routine screening for depressive symptoms to identify those at higher risk for angina,” Maddox and his colleagues wrote.

Patients could be treated with antidepressants, but the researchers were unsure if these medicines would decrease the chest pain.

Smoking was also a big contributor to the persistent chest pain, but the researchers said more work needs to be done in order to help smokers quit after they have a heart attack.

Smoking is a well-documented cause of heart disease and it increases the risk of a second heart attack and death.

Click here to read the full story from Reuters.