Heart disease remains the leading cause of death for both men and women in the United States. As per the Center for Disease Control and Prevention (CDC), about 1 in every 4 deaths is caused by heart disease.

While chest pain and shortness of breath are the most commonly known symptoms of heart disease, there are other more surprising ways your heart may be trying to tell you that something is wrong. Here are six unexpected indicators of heart disease.

1. Erectile Dysfunction

Erectile dysfunction (ED) is a condition where a man has difficulty achieving or maintaining an erection. Research shows that men with ED have a higher risk of heart disease, even after adjusting for factors such as age, smoking, and diabetes.

ED and heart disease are linked because both conditions share the same risk factors including high blood pressure, high cholesterol, and diabetes. More research is needed to determine the exact link between ED and heart disease, but men with ED should be screened for heart disease by their doctor.

2. Creased Earlobes

There is a theory that a diagonal crease on the earlobe, known as Frank’s sign, is a sign of heart disease.

The crease, which is thought to be caused by poor blood flow to the earlobe, was first noticed by a doctor named Sanders Frank in the 1970s. While more research is needed to determine if there is a definitive link between earlobe creases and heart disease, some studies have found a correlation between the two.

If you have earlobe creases along with other risk factors for heart disease, such as high blood pressure or high cholesterol, it’s a good idea to talk to your doctor.

3. Gum Disease

Gum disease, also known as periodontal disease, is a bacterial infection that affects the gums and the bones that support the teeth. Research has shown that gum disease is linked to an increased risk of heart disease.

It is thought that the bacteria that causes gum disease can enter the bloodstream and contribute to the formation of plaques in the arteries. To reduce your risk of gum disease and heart disease, make sure to brush and floss regularly, and see your dentist for regular check-ups and cleanings.

4. Sleep Apnea

Sleep apnea is a condition where a person’s breathing is interrupted during sleep. Research has shown that people with sleep apnea have an increased risk of heart disease, even after adjusting for other risk factors such as obesity and smoking.

Sleep apnea is thought to be linked to heart disease because it can cause high blood pressure, which is a major risk factor for heart disease. If you snore or suspect that you have sleep apnea, talk to your doctor about getting tested and treated.

5. Dizziness or Fainting Spells

Dizziness or fainting spells can be a sign of a heart rhythm problem, such as arrhythmia. Arrhythmias are abnormal heart rhythms that can be caused by a variety of factors including high blood pressure, heart disease, and genetics.

If you experience dizziness or fainting spells, especially if they are accompanied by other symptoms such as palpitations or chest pain, it’s important to see your doctor right away.

6. Indigestion or Nausea

Indigestion or nausea can be a sign of heart trouble, especially in women. Women are more likely than men to experience non-chest pain symptoms of a heart attack, including indigestion, nausea, or abdominal pain.

These symptoms can be easily dismissed as something else, but it’s important to listen to your body and seek medical attention if you experience any unusual symptoms.

Knowing these unexpected indicators of heart disease can help you and your doctor detect the condition earlier. Early detection and treatment can improve your chances of living a longer, healthier life.