Whether the reason is fear, denial, mistrust of the healthcare system, downplaying symptoms, or misguided masculinity, the repercussions of avoiding medical care become riskier—even potentially deadly—as men age. While many averagely healthy men can get away with skipping the doctor early in adulthood, age-related chronic conditions become more common once they hit middle age. This is especially the case when it comes to the risk and prevalence of cardiovascular disease, which is the top killer of men in the U.S., and why it’s critical to take new and unexplained health symptoms seriously. 

“Don’t ignore your wellness, and don’t give your wellness, or your health, a three-month break,” says Dr. Steven Lamm, director of the Preston Robert Tisch Center for Men’s Health at NYU Langone. Lamm also urges men to become familiar with their baseline numbers, including blood pressure, cholesterol and blood sugar, which are essential for spotting current or future heart disease. It’s also critical to be aware of some of the lesser known symptoms of heart disease before they become an emergency.

Dr. Antonio Fernandez, medical director of the cardiac intensive care unit and preventive cardiology at Hartford Hospital, always reminds patients that timing is key.

“With some of the cardiac conditions, the symptoms can progress over time,” says Fernandez. “So, obviously, if there were to be a cardiac problem, catching that early would be better than waiting too long and then dealing with a more severe problem.”

Here are five symptoms that should prompt men to visit a doctor.

1. Unexplained fatigue

From parenting and working demanding jobs to keeping up with friends and hobbies to caretaking of aging parents—routine life is demanding and exhausting. It’s no surprise then that many men experience periods of higher levels of exhaustion. But if fatigue begins to feel extra crippling and chronic, it is most certainly time to seek out a professional since there’s a strong association with heart disease. 

One study found that men with moderate-to-high levels of exhaustion had a 2.7-fold increased risk of heart attack within five years and a 2.25 higher risk within ten years. The study also found a strong correlation between high blood pressure and moderate-to-high levels of exhaustion in two-thirds of the cohort.

Additionally, says Lamm, fatigue is related to other serious conditions in men, and is especially associated with depression. Mental health is intrinsically tied to physical health and research finds that, in particular, depression is strongly associated with a higher risk of heart attack and stroke. The good news is studies also find treating depression can directly affect heart attack risk since depression often worsens lifestyle habits that are related to cardiovascular disease such as eating a poor diet and consuming alcohol.

2. Chest discomfort

A feeling of pressure and squeezing in the chest is a serious indication that medical care is essential because chest pain and discomfort is one of the most common symptoms of heart attack in men. Chest pain and discomfort may occur during a heart attack because the heart is not getting enough oxygen-rich blood. Knowing this is reason enough to seek out care. However, chest pain and discomfort is often mistaken for a number of other condition including anxiety attacks and run-of-the-mill digestive problems.

“Don’t ignore and don’t go to sleep with chest pain, thinking that it’s reflux,” says Lamm. “Do not assume that your chest pain is due to hyperacidity. It can be a really important clue that you’re having a coronary. Do not go to sleep with chest pain, because you may not wake up.”

3. Swelling in lower extremities

Lower extremity edema, or swelling, is often a first sign of heart failure. Fluid builup in the lower legs, feet and hands—also known as pedal edema— occurs because the heart’s ability to pump blood is too weak, which causes the blood to settle and accumulate in tissue. Some research also finds that edema is a predictor of progressive heart failure.

Edema can be associated with other health conditions as well, including kidney disease, cirrhosis of the liver and thyroid disease. It can also be the result of too much sitting or consuming salty foods. However, if it becomes a chronic that’s reason enough to see a clinician, says Fernandez.

4. Change in exercise tolerance

We all have days when your energy level is not what it usually is, when a few flights of stairs leave you winded and your routine workout at the gym is barely tolerable. However, when you notice that exertion fatigue is more frequent and different than your normal baseline, it’s time to see a doctor.

“Don’t ignore shortness of breath or change in exercise tolerance, because it can be a very important signal that you’re blocking off your coronary arteries,” says Lamm.

Tracking your fitness performance with a smartwatch can help you monitor changes and raise red flags if there’s a sudden or gradual shift in your cardiovascular exercise levels. And it’s critical to take action if exercise intolerance is coupled with other symptoms such as lightheadedness and chest discomfort, says Fernandez.

5. Loss of morning erections

Men often avoid talking about their sexual health with doctors or seek out care if things seem to be off. However, one of the most important indicators of heart health for men is their ability to get and maintain an erection.

“Erectile dysfunction could be a sign of atherosclerosis, which is plaque built up in the arteries suggest people could have peripheral disease and develop lower extremity pain with walking,” explains Fernandez.

When assessing a patient’s overall cardiovascular health, one the first things Lamm asks about is their sexual function, specifically if they are regularly experiencing morning erections.

“To have an erection requires the orchestration of so many different organ parts, your brain, your nervous system, blood vessels, your hormones,” notes Lamm. “So once a man is no longer waking up with a morning erection, that is an indicator that there’s something off, especially in your forties.”

Failure to get and maintain an erection during sex can be related to a host of other factors include anxiety or relationship issues, though cardiovascular health should always be assessed, he says. However, loss of regular morning erections should always prompt a visit to your doctor for full cardiovascular evaluation, and it should not be delayed.

More on healthy aging:

• 6 foods that could be making you age faster
• The 5 best supplements for healthy aging, according to a longevity expert
• A good workout routine can help you age better than your parents did. Here’s how
• 5 expert-backed ways to improve brain health at every age