Heart disease is still the leading cause of death in the US, and doctors in Hawaii say most of it can be caught early enough to prevent — good news for anyone willing to get checked.

• Hawaii's food culture and the shift to processed food drive high blood pressure and high cholesterol, the two biggest warning lights.
• People who look perfectly healthy can still have clogged arteries, so looks are no proof of a healthy heart.
• A new heart CT scanner at Adventist Health Castle can spot even tiny amounts of plaque years before it causes a heart attack.
• The scan is a quick, open "donut" shape rather than a closed tube, so people who fear tight spaces can still take it.
• The earliest sign of trouble is usually mild: getting winded on a hike you used to finish easily. Sudden chest pain or breathlessness means call 911.

Outlook: Cardiology is shifting toward catching heart disease before symptoms start, so expect more push toward routine blood pressure, cholesterol, and imaging checks.