Eating breakfast every day has always been considered an important part of a healthy lifestyle, but a new study from the University of Iowa shows just how important it is.

The study, by Wei Bao, assistant professor of epidemiology in the University of Iowa College of Public Health, finds that people who never ate breakfast had an 87% higher risk of death caused by cardiovascular disease than people who ate breakfast every day. Published in the Journal of the American College of Cardiology, it supports the benefits of eating a daily breakfast in promoting heart health.

Bao says health-care providers and dietary experts have known for years the importance of eating breakfast every day. The early-morning calories jumpstart the body’s metabolism and give people the energy and nutrients needed to start the day. But despite evidence that suggests skipping breakfast leads to increased risk of obesity, high blood pressure, type 2 diabetes, and other health complications, fewer people report they are making the meal a part of their daily routine.

Bao says the new study is the first to evaluate breakfast’s impact on the risk of cardiovascular death. Researchers used data from the National Health and Nutrition Examination Survey, an annual survey from the US Centers for Disease Control and Prevention. The researchers used data from 6,550 Americans age 40 to 75 years gathered between 1988 and 1994 who were asked how often they ate breakfast.

Among them, 5.1% reported never eating breakfast, 10.9% said they rarely ate breakfast, 25% said they ate breakfast some days, and 59% said they ate breakfast every day. Analysis found that those participants who never ate breakfast were 87% more likely to die from cardiovascular disease and stroke than those who ate breakfast every day, after accounting for demographic, socioeconomic, dietary, lifestyle factors, body mass index, and cardiovascular risk factors.

Bao says skipping breakfast was associated with elevated blood pressure and changes in appetite so that a person doesn’t feel full and overeats later in the day. It also leads to harmful changes in lipid levels, such as higher levels of total cholesterol and low-density lipoprotein cholesterol, or “bad cholesterol,” which leads to an increased likelihood of cardiovascular disease.

He says skipping breakfast also was a behavioral marker for unhealthy lifestyle habits, as those who never ate breakfast were more likely to be overweight, heavy drinkers, former smokers, and physically inactive, and have high cholesterol, lower incomes, and poor diet quality. These markers also can lead to increased risk of cardiovascular disease.

But even after adjusting for those lifestyle factors, the authors note a significant association between skipping breakfast and cardiovascular mortality.

Study co-authors include Shuang Rong, a University of Iowa visiting scholar now at the Wuhan University of Science and Technology, Wuhan, China; and Linda Snetselaar, Guifeng Xu, Yangbo Sun, Buyun Liu, and Robert Wallace of the University of Iowa. It was published in the journal’s April 30 edition.