The States With the Least Heart Disease

March 13, 2019 by Steven M. Peters

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No other condition kills more people in the United States than heart disease. One in every four deaths is caused by heart disease, or 610,000 deaths a year. On average, 6.9% of American adults have some form of major cardiovascular disease and 3.6% have suffered a heart attack.

High blood pressure, high cholesterol, and smoking are major risk factors for heart disease. Nearly half of Americans either have one of the conditions or smoke. In addition to smoking, unhealthy behaviors such as poor diet and lack of physical activity also increase a person’s risk of developing a cardiovascular disease.

Maintaining a healthy weight through exercise, eating a proper diet, or both can help lower the risk of heart disease. Though it is not always the case, states with relatively lower shares of heart disease among the adult population tend to report healthier habits. For example, the three states with the smallest share of adults living with heart disease also have the three largest shares of people of normal weight. Also, the states with the highest rates of adult obesity tend to have the highest rates of heart disease among disease — though not always.

Across populations, other risk factors for cardiovascular disease can have an impact on its prevalence. Six of the 10 states with the lowest shares of adults with heart disease also have among the lowest inactivity rates among adults in the United States. The other four are not far behind.

Seven of the 10 states with the lowest rates of heart disease are among the top 15 of states with the lowest poverty rates in the country. The median annual household income in most of these states is up to $20,000 above the national median of over $60,000.

To determine the states with the most heart disease, 24/7 Wall St. reviewed the share of residents 18 or older who had a major cardiovascular disease as of 2015, the latest year for which data was available, with data from the U.S. Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System. Also from the CDC BRFSS we reviewed the share of adults who had coronary disease and at least one episode of heart attack as of 2015. Population figures are from the U.S. Census Bureau’s 2017 1-year American Community Survey.

Click here to read about the states with the least heart disease.

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25. Arizona
> Adults with cardiovascular disease: 6.9% (tied with Maryland)
> Adults who’ve had heart attack: 3.7% (22nd highest)
> Population: 7,016,270

In Arizona, 6.9% of adults live with heart disease, in line with the national rate. Many of the risk factors for heart disease are as prevalent among the state population as they are nationwide. The adult obesity and excessive drinking rates are in line with the average nationwide. Poverty, however, can be a risk factor, according to a University of California at Davis study. People who live in poverty have less access to health care and healthy food — two other known risk factors — and Arizona has the 11th highest poverty rate in the country.

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24. Virginia
> Adults with cardiovascular disease: 6.8%
> Adults who’ve had heart attack: 3.2% (12th lowest)
> Population: 8,470,020

Virginia is one of the wealthiest states in the nation with a median household income of more than $71,000 a year. Wealthier areas tend to have a lower risk of heart disease in part due to increased access to health care and healthier lifestyles. The share of adults with cardiovascular disease in Virginia is close to the national share of 6.9%. This may be partially attributable to the fact that it has one of the 10 highest shares of overweight residents at 36.3%. Though being overweight is not as severe a risk as obesity, it increases the risk of heart disease.

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23. Nevada
> Adults with cardiovascular disease: 6.8%
> Adults who’ve had heart attack: 3.7% (22nd highest)
> Population: 2,998,039

While the adult obesity rate and the share of adults who do not engage in physical activity in Nevada are below the national averages, the state has one of the highest shares of uninsured residents. About 11.2% of state residents lack health coverage, the eighth highest uninsured rate in the country and higher than the 8.7% uninsured rate nationwide. Lack of coverage may discourage people from seeking help because doctor visits, tests, and treatment can be too expensive.

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22. Washington
> Adults with cardiovascular disease: 6.7%
> Adults who’ve had heart attack: 3.4% (16th lowest)
> Population: 7,405,743

Physical activity is one of the most common ways people can reduce the risk of heart disease, and Washington has one of the highest rates of active adults of any state. Just 19.2% of adults got no physical activity in the last month, as compared to 25.7% of all American adults. Another behavior associated with heart disease, smoking, is also relatively rare in the state. Just 13.5% of adults smoke in Washington, one of the five lowest smoking rates of all states and well below the U.S. 17.0% smoking rate.

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21. Wyoming
> Adults with cardiovascular disease: 6.7%
> Adults who’ve had heart attack: 4.0% (17th highest)
> Population: 579,315

Major risk factors of heart disease among Wyoming’s population, including high blood pressure, high cholesterol, and obesity, tend to be less or as prevalent as they are nationwide. Still, the state has one of the highest shares of adults who do not have health insurance and who do not consider anyone their personal doctor or health care provider. Also, the number of primary care doctors per capita is among the 15 lowest among states. Skipping regular checkups may result in undiagnosed — and untreated — conditions leading to heart disease.

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20. Nebraska
> Adults with cardiovascular disease: 6.6%
> Adults who’ve had heart attack: 3.4% (16th lowest)
> Population: 1,920,076

Nebraska has a relatively low rate of cardiovascular disease among its adult population. It is one of the most heavily medicated states. More than 65% of adults in the state take blood pressure medication, as compared to 61% of American adults. Some of Nebraska’s residents are increasing their risk of heart disease by consuming too much alcohol. More than one in five adults in the state report binge drinking, one of the highest binge drinking rates in the nation. Excessive or frequent alcohol use can lead to high blood pressure or other circulatory issues, which are risk factors for heart disease.

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19. Massachusetts
> Adults with cardiovascular disease: 6.6%
> Adults who’ve had heart attack: 3.5% (23rd lowest)
> Population: 6,859,819

Massachusetts has the highest share of adults reporting being in excellent health and is the state that has the highest rate of insured residents. The adult obesity rate is among the lowest and the number of doctors per 100,000 people is among the highest in the country. The adult smoking rate is among the lowest, too. However, the share of adults who are considered binge drinkers (five or more drinks on one occasion for men and four or more for women) is among the highest. Alcohol is a major risk factor for stroke and heart failure. It increases the level of fats in the blood, which may lead to restricted flow to the brain and other organs.

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18. North Dakota
> Adults with cardiovascular disease: 6.6%
> Adults who’ve had heart attack: 3.5% (23rd lowest)
> Population: 755,393

A relatively high share of North Dakota adults, 38.3%, have a healthy weight — the fourth highest rate in the country. This means that many state adults are not at an increased risk of heart disease and other circulatory issues. North Dakota adults also tend to feel well, reporting some of the lowest rates of mentally and physically unhealthy days of all states. However, the state has the highest binge drinking rate in the nation, as some 23.3% of adults in the state drink to excess. This may be partly why North Dakota is not higher on the list, despite other healthy behavior and lifestyle indicators.

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17. New York
> Adults with cardiovascular disease: 6.6%
> Adults who’ve had heart attack: 3.5% (23rd lowest)
> Population: 19,849,399

New York has one of the lowest rates of adult obesity in the country. In addition, more than a quarter of residents don’t exercise, which is above the national inactivity rate of 23.0%. Smoking is another risk factor, causing about one in four CVD-related deaths, and in New York, the adult smoking rate is also among the lowest in the country.

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16. Rhode Island
> Adults with cardiovascular disease: 6.5%
> Adults who’ve had heart attack: 3.5% (23rd lowest)
> Population: 1,059,639

With about 96 primary care physicians per 100,000 residents, Rhode Island residents more access to health care than the average American. Nationwide, there are less than 76 primary care doctors per 100,000 people. Rhode Island also has one of the highest rates of insured residents at 92.8%. This means that residents are more likely to visit a doctor and get treatment for chronic conditions or to schedule medical checkups that may detect heart problems before they become more serious.

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15. Vermont
> Adults with cardiovascular disease: 6.4%
> Adults who’ve had heart attack: 3.6% (25th highest)
> Population: 623,657

Vermont has one of the smallest shares of obese adults and people who do not exercise. The adult smoking rate is in line with the national average. But the state has the eighth highest excessive drinking rate in the country, which may be offsetting healthy habits that are common among residents. More than one in five adults drink too much, compared to a national excessive drinking rate of 18.0%. Alcohol increases the risk of heart disease because it has been linked to irregular heart beat, raising blood pressure, and increased level of LDL (bad) cholesterol in the blood.

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14. Iowa
> Adults with cardiovascular disease: 6.4%
> Adults who’ve had heart attack: 3.6% (25th highest)
> Population: 3,145,711

With more than 36% of state adults considered obese, Iowa is the only state to have both one of the five highest obesity rates in the country as well as a lower share of adults with a major cardiovascular disease than the national share. Obesity is a risk factor of heart disease. Iowa adults also have a relatively low rate of high blood pressure, at 27.2% compared to the 29.1% U.S. rate. Iowans typically feel well, reporting a U.S.-low 2.9 physically unhealthy days per month.

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13. Oregon
> Adults with cardiovascular disease: 6.4%
> Adults who’ve had heart attack: 3.0% (5th lowest)
> Population: 4,142,776

About one in three adults in Oregon have a high blood pressure, a major risk factor for heart disease because the arteries become narrow due to the buildup of fat. The state, however, also has one of the largest shares of adults with high blood pressure taking medication for hypertension, at 63.6% compared to a national share of 61.0%. The state has the third highest share of adults who eat at least the recommended amount of fruits and vegetables a week. A healthy diet is key to preventing cardiovascular disease. Another key factor that may explain the low heart disease rate among Oregon’s adults is physical activity. The state has the second highest share of adults who exercise regularly.

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12. Idaho
> Adults with cardiovascular disease: 6.3%
> Adults who’ve had heart attack: 3.3% (14th lowest)
> Population: 1,716,943

In addition to a relatively low rate of cardiovascular disease, Idaho adults also have the fifth lowest incidence of coronary heart disease at just 2.7%. This is likely due in part to the lower prevalence of unhealthy behaviors among state adults. Most adults reported they did not have a single drink of alcohol within the last month, and the state has some of the lowest adult smoking rates in the nation. Alcohol and smoking increase the risk of heart disease.

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11. Wisconsin
> Adults with cardiovascular disease: 6.3%
> Adults who’ve had heart attack: 3.5% (23rd lowest)
> Population: 5,795,483

Factors that normally lead to healthy outcomes, such as normal cholesterol levels, eating a healthy diet, and exercising on regular basis, are common among Wisconsin’s adult population. The state, however, also has the second highest adult binge drinking rate of all states. Binge drinking increases the risk of developing heart disease. The state has the seventh highest share of insured adults, which also may contribute to the lower prevalence of heart disease as health coverage may encourage people to go for regular checkups.

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10. Montana
> Adults with cardiovascular disease: 6.2%
> Adults who’ve had heart attack: 3.1% (9th lowest)
> Population: 1,050,493

Like most of the states where the adult population reports a relatively low rate of cardiovascular disease, Montana has a very low obesity rate, the fifth lowest of all states. Just 25.3% of adults in the state are obese, well below the U.S. adult obesity rate of 31.6%. Montana is one of just six states in which at least 90% of adults regularly eat the recommended amount of fruits and vegetables. This healthy diet may be at least in part the reason that just 28.3% of Montana adults have high total cholesterol, the second lowest share of any state.

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9. New Jersey
> Adults with cardiovascular disease: 6.1%
> Adults who’ve had heart attack: 3.2% (12th lowest)
> Population: 9,005,644

Major risk factors of heart disease, such as smoking and excessive drinking, are far less common among the New Jersey adult population than they are on average nationwide. The adult obesity rate of 25.9% is below the national rate of 28.0%. The state also has some of the country’s highest concentrations of primary care physicians and dentists, who are sometimes the first to diagnose problems such as bleeding gums that can be indicative of potential development of heart disease.

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8. Alaska
> Adults with cardiovascular disease: 6.0%
> Adults who’ve had heart attack: 2.9% (3rd lowest)
> Population: 739,795

In Alaska, 97% of adults have been screened for high cholesterol in the past five years, the fifth highest rate among all states. Early screenings are crucial to catching heart issues before they become a serious health risk. This may be one reason why just 2.9% of Alaskan adults have reported they had a heart attack in the past, the third lowest share of any state and well below the 4.2% U.S. rate.

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7. California
> Adults with cardiovascular disease: 6.0%
> Adults who’ve had heart attack: 2.8% (2nd lowest)
> Population: 39,536,653

California has the fifth lowest share of adults with high blood pressure and the fourth highest share of adult residents with healthy weight. The shares of adults with high cholesterol and those who smoke are also among the lowest in the country. Healthy habits such as eating fruits and vegetables and exercising also are common. The Golden State’s 22.7% adult obesity rate is the third lowest of any state and lower than the national obesity rate of 28.0%.

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6. Connecticut
> Adults with cardiovascular disease: 6.0%
> Adults who’ve had heart attack: 3.2% (12th lowest)
> Population: 3,588,184

With a median annual household income of more than $74,000, Connecticut is one of the wealthiest states. With such high incomes, a greater share of residents are able to afford health care such as regular doctor visits, screening, prevention, and medication. Connecticut adults tend to lead some of the healthiest lifestyles of adults of any state. A very low share drinks excessively or smokes cigarettes, and an above average share reports getting physical activity on a regular basis.

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5. New Hampshire
> Adults with cardiovascular disease: 6.0%
> Adults who’ve had heart attack: 3.1% (9th lowest)
> Population: 1,342,795

Only 6% of New Hampshire adults have heart disease, one of the lowest shares of any state. This may be partly explained by the residents’ healthy habits, such as exercising regularly. Socioeconomic factors, which research has shown are related to health, may play a role, too. The state has the lowest poverty rate of any state and one of the largest shares of household with an estimated annual income of more than $200,000. Wealthy people are more likely to have better access to medical care, eat a healthy diet, be more active, and experience less stress.

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4. Utah
> Adults with cardiovascular disease: 5.8%
> Adults who’ve had heart attack: 3.1% (9th lowest)
> Population: 3,101,833

Utah adults are among the healthiest in the nation. The state has has by far the lowest smoking rate of any state at 8.9% — the next lowest smoking rate is in California with an 11.0% of adults smoking. Utah adults are also the least likely to binge drink and the most likely to eat the recommended amount of fruits and vegetables in their diet. These healthy lifestyle choices have likely helped make Utah one of just four states with a cardiovascular disease rate among adults of less than 6%.

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3. Minnesota
> Adults with cardiovascular disease: 5.8%
> Adults who’ve had heart attack: 3.1% (9th lowest)
> Population: 5,576,606

Minnesota is among the 10 states with the highest share of healthy-weight adult residents. Maintaining a healthy body mass index is key to preventing cardiovascular disease. Excess fat can increase the risk of diabetes and hypertension, both of which can contribute to the development of heart disease. The state has one the smallest shares of people who do not participate in physical activities. Regular exercises can also help prevent heart disease.

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2. Colorado
> Adults with cardiovascular disease: 5.7%
> Adults who’ve had heart attack: 3.0% (5th lowest)
> Population: 5,607,154

Coloradans are some of the most active Americans, with 58.7% of adults reporting they get at least 150 minutes of exercise per week. Colorado residents are the most likely to be in good physical condition, as 39.0% of adults in the state have a normal BMI, as opposed to being underweight, overweight, or obese — all conditions that can put strain on a person’s heart. Along with the low cardiovascular disease rate among state adults, Colorado also has the lowest rate of adults with coronary heart disease and the lowest share of adults who have suffered a heart attack.

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1. Hawaii
> Adults with cardiovascular disease: 5.4%
> Adults who’ve had heart attack: 2.5% (the lowest)
> Population: 1,427,538

Hawaii has the lowest share of adults living with cardiovascular disease in the United States. The state has one of the lowest shares of adults with high cholesterol as well as one of the lowest smoking, inactivity, and obesity rates among adults of any states. All these are considered high risk factors for developing heart disease and may help explain why the state has a nation-leading low share of the disease among adults. The fact that the state also has some of the highest numbers of primary doctors and dentists per 100,000 people may also help explain the Aloha State’s low rate of heart disease and also why Hawaii is the state where people live the longest.