Arizona’s hottest summer on record raised power bills and heat-related ER visits.

Now, a new paper in the journal Circulation projects that extreme heat from climate change will more than double, or possibly triple, excess deaths from cardiovascular disease by midcentury.

Heat and health models project a more than 160% increase under proposed emissions reductions and a more than 230% rise if those goals are ignored or undercut.

Seniors and Black people, who make up one-fifth and one-twentieth of the state’s population, respectively, are expected to be hardest hit.

Although Arizona ranks only 35th in the U.S. for deaths from heart disease, it’s still the state’s leading cause of death.