Khat, a natural stimulant recently spreading throughout Western Europe and the U.S. can cause increased stroke and heart attack incidence for those with heart disease according to a new study published in Circulation: Journal of the American Heart Association.

Chewed by East Africans and Arabians for centuries, the Catha edulis plant can produce effects similar to amphetamines and cocaine. Known today as khat, these effects include euphoria, weight loss, lack of appetite, and hyperactivity.

The study compared participants mostly from Arabian countries, including about 96% of them from Yemen where khat chewing is socially and legally acceptable, with non-khat chewers. The death rate from heart disease for khat users were about double that of the control group in all categories assessed (in the hospital, at one month, and at one year). Users were also more likely to experience adverse health effects such as second heart attacks or heart failure.

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