Heart disease is the leading cause of death for both men and women in the U.S., often developing over decades before symptoms become impossible to ignore. Most people see a cardiologist for the first time after unexpected results of a lab report, experiencing shortness of breath or a flutter in the chest. But visiting a cardiologist doesn’t always need to happen when something is wrong — a visit can also help prevent or catch heart disease early.

“Seeing a cardiologist allows you to have a really comprehensive conversation about your heart disease risk and what it means to you as an individual,” says Dr. Corey Bradley, a cardiologist at NewYork-Presbyterian/Columbia University Irving Medical Center. “What is your family history of heart disease? Did you go through menopause early? Did you have complications during pregnancy? Those are some questions I ask in conversations with my patients. It’s really personalized.”

To learn more about when to see a cardiologist and what to expect for your visit, Health Matters spoke to Dr. Bradley.

When should you see a cardiologist?

Dr. Bradley: If you have a family history of a cardiovascular disorder, whether it be heart disease or aortic disease, you should see a cardiologist. Also, if you have symptoms that are related to your heart and a cause for concern, it could be an indicator of early cardiovascular disease. The symptoms could be obvious — like chest pain, shortness of breath or heart palpitations — or they may be more subtle, like a change in your exercise tolerance.

You can also make an appointment with a cardiologist if you have questions that you feel are beyond the scope of your primary care doctor. I see patients all the time who are simply nervous about their lab results or just want to ask about being high risk because of family history. The visit with a cardiologist allows both of you to dig in deeper and understand the context of your numbers and risk.

If you have a family history of heart disease, at what age should you see a cardiologist?

It’s never too early to see a cardiologist if you have a family history. The earlier that we think about heart disease risk the better, whether that means starting medication immediately or just being aware of what could develop.

The good news is parents tend to share more with their children about their health now; it’s less taboo to speak about your health issues than it was 30 years ago. And I think young people are also taking more ownership of their health. People want to know about their risk.

What happens at the first visit with a cardiologist?

The first visit usually includes a physical exam and family history. Sometimes a patient needs one visit, and I go over lab results and complete their risk profile to better understand their needs. In other cases, I identify a genetic disorder that is causing abnormal lipid levels, and that requires close, regular follow-up.

Should you see a cardiologist if you have high blood pressure or high cholesterol?

It’s important to know your blood pressure because untreated high blood pressure can lead to long term health complications. If you are not responding to first-line blood pressure management with your primary care doctor, it may be helpful to talk to a specialist.

If your cholesterol test (also called a lipid panel) shows an LDL cholesterol of over 190 mg/dL, you really want to have a conversation about what those labs mean. Other important tests to discuss with a specialist are apolipoprotein B (ApoB) and lipoprotein(a) because they evaluate cardiovascular risk.

Outside of severely elevated cholesterol, however, what is considered “normal” on your lipid panel really depends on your personal risk factors for heart disease and should always be interpreted in the context of your personal medical and family history.

Who should get a stress test and when do people need to get one?

If you are having symptoms of chest pain or shortness of breath with exertion, a stress test may be done to help determine if the symptoms are related to your heart. There are several different types of stress tests, as well as specialized CT scans of the heart, that can be used — it depends on your circumstances and what your doctor feels would be the best choice for you.

Why is early intervention important when it comes to preventing heart disease?

I feel very passionate about this: You’re never too young to start thinking about prevention. Coronary heart disease happens over decades; it’s a slow process of plaque accumulation. So we should start interventions (like a regular exercise routine and eating a low-salt diet emphasizing plants and lean protein) when we’re all in our 20s, not waiting until we are already having symptoms of heart disease in middle age.

What heart symptoms mean I should call 911 right away?

The major symptoms of a heart attack include:

• Chest pain or discomfort (including tightness or pressure in the chest)
• Shortness of breath
• Pain or discomfort in one or both arms, the shoulders, back, neck, or jaw.
• Feelings of weakness or fatigue
• Feeling lightheaded or faint
• Breaking out in a cold sweat
• Feelings of heartburn or indigestion
• Nausea

If you have sudden symptoms that could be a life-threatening heart problem, call an ambulance. But some people also experience warning signs for hours, days, or weeks. That persistent chest pain or pressure is a typical warning sign, so speak to a doctor if you experience these symptoms.