Heart disease remains the leading cause of death in the U.S., according to a new report from the American Heart Association. It has held the top spot since 1921, yet approximately half of the population is unaware of this silent killer.

It’s not just heart disease that’s taking lives. , including heart disease and stroke, claim more American lives than all forms of cancer and accidental deaths – the second and third top causes of death – combined.

When it comes to cardiovascular health, prevention is key. Unfortunately, many people aren’t proactive about their health care.

“A large portion of the population does not seek medical care after their last school physical,” says Dr. Jeffrey Freihage, an interventional cardiologist with Advocate Health Care. “They are not engaged in health care again until they are much older when issues arise. They might be feeling well in their 20s, 30s, 40s and even 50s, but there can be unseen damage done to the cardiovascular system.”

Dr. Freihage offers five ways to be proactive about your cardiovascular health: