You have erectile dysfunction (ED).

Men have a built-in warning system for silent CHD. When achieving an erection is difficult or impossible, it can be a sign of clogged arteries in the pelvis that presents before a heart attack hits. There are, on average, three to five years between the onset of ED and the finding of CHD, which is plenty of time to detect and to work on preventing heart issues. If you and your partner are worried about sexual performance, look for and treat root causes of diseased arteries before just popping a blue pill.

You’re going bald.

In a comprehensive study of almost 37,000 men, severe baldness at the crown of the head strongly predicted the presence of silent CHD at any age. In a separate study of more than 7,000 people (including over 4,000 women), moderate to severe baldness doubled the risk of dying from heart disease in both sexes.

You have gray hair.

A new study presented in Europe at EuroPrevent 2017 found that a high amount of gray hair is a risk factor for silent heart atherosclerosis. A total of 545 adult men without known heart disease had a CT angiogram of their heart arteries, a very accurate way to identify silent problems. Having equal amounts of gray and dark hair, or mainly gray and white hair, correlated with finding silent heart blockages. The researchers commented that “atherosclerosis and hair graying occur through similar biological pathways.”

You have a diagonal earlobe (yes, really!).

One of the stranger markers, a crease in your earlobe (specifically, an angled crease in the ear that runs diagonally from the canal to the lower edge of the earlobe) has been mentioned in medical research reports as a sign of silent CHD for decades. The ear crease may result from poor circulation, including in arteries in the heart. Although some medical professionals have argued that a crease is just a general sign of aging, researchers last year used the most sophisticated CT scan method to measure silent CHD and found that ear crease predicted heart disease even after the authors accounted for other risk factors, such as age and smoking.

You have calf pain when you walk.

This is known as claudication (from the Latin for “to limp”). Atherosclerosis can block leg arteries, particularly in smokers, before CHD is diagnosed. This symptom requires an evaluation without delay. Your doctor will examine the pulses in your legs and perform simple measurements of leg blood pressure and blood flow to confirm a diagnosis of poor circulation.

It is critical that heart disease be diagnosed as early as possible because there are many dietary and medical treatments that can help reverse the issue. Some of my patients took these early clues to heart. Anyone with any of the above clues to silent heart issues should know his or her numbers (blood pressure, cholesterol, fasting glucose). Asking your doctor for an EKG or a coronary calcium CT imaging is wise, whether you are a woman or man. Changing your lifestyle right away to ban smoking, walking, managing stress, and adding a plant-based diet can reverse problems before they attack your health or life. To borrow from Ben Franklin, an ounce of prevention (plus a bowl of kale) is worth a pound of cure.

Want to learn more from Dr. Kahn about keeping your heart healthy? Check out the first-ever functional nutrition training, where he teaches classes on heart health and veganism.