Heart disease, which causes heart attacks, is the leading cause of death in the United States. More than 700,000 Americans have a heart attack each year.

According to the Gallup-Healthways annual well-being study, some U.S. metropolitan regions have much higher rates of heart attacks than the rest of the country. Nationally, an estimated 4% of American adults reported surviving a heart attack. Residents of the Huntington-Ashland metropolitan region were more than twice as likely to suffer the same fate. Based on Gallup and Healthways data for U.S. metropolitan statistical areas, 24/7 Wall St. reviewed the cities with the highest rates of heart attacks.

Click here to see the cities where people are having heart attacks

Not surprisingly, metropolitan areas that had higher rates of heart attacks than the national average exhibited many of the poor habits associated with heart disease, including poor exercise habits and high smoking rates. Residents in the majority of these places were among the least likely to exercise regularly. Several areas had among the highest smoking rates in the country. In the Charleston and Huntington areas, more than 30% of residents smoked, compared to less than 20% across the country.

While poor diet is commonly associated with heart conditions, many of these metropolitan areas reported healthy eating habits. In Cape Coral, which had the eighth-highest rate of adults who had experienced a heart attack, nearly 75% of those surveyed reported eating healthy all of the day before. Nationally, the rate was 66.5% of those surveyed.

Gallup.com Deputy Managing Editor Elizabeth Mendes explained to 24/7 Wall St. that “In general, residents living in metro areas with high rates of heart attacks also struggle more with chronic health problems like high blood pressure, obesity, and diabetes.” In Huntington, the top region in the country for heart attacks, an estimated 43.3% of surveyed adults reported suffering from high blood pressure, compared to just 27.6% of adults nationwide. The area was also in the top five for high cholesterol and obesity.

Mendes explained that Gallup has noted a relationship between low income and poor health, including heart attacks. Part of this may have to do with access to quality care, poor health habits related to a lack of education or affordable, healthy food. Based on the most recent Census data, most of the metro areas with the highest risk of heart disease had median household incomes below the U.S. figure of $50,502. At the same time, most of the 10 of the areas with the lowest rate of heart attacks had a median income above the national figure.

To determine the 10 metropolitan areas where the most people had a heart attack, 24/7 Wall St. reviewed figures from the Gallup-Healthways Well-Being Index for 2012. The study was based on interviews with more than 230,000 adults ages 18 and over in 189 different metropolitan areas across the country. In addition to the percentage of residents who have had a heart attack, we considered a variety of data from the Well-Being Index, mostly concerning physical health and healthy behaviors practiced by residents. We also reviewed median income, poverty rates and educational attainment from the U.S. Census Bureau. All Census figures were for 2011, the most recent available year.

These are the cities with the most heart attacks.