Though the COVID-19 pandemic has killed more than 220,000 Americans in 2020, it is not the top cause of death in the country. One in every four deaths in the United States, or 655,000 deaths a year, are caused by heart disease.

Heart disease is by far the leading cause of death for men, women, as well as for all people in most racial and ethnic groups.

24/7 Tempo reviewed the share of residents 18 or older who had a major cardiovascular disease in 2018, the latest year for which data is available, to determine the states with the largest and smallest share of the population suffering from heart disease.

On average, 7.4% of American adults had some form of major cardiovascular disease as of 2018 and 3.8% have suffered a heart attack, up from 6.9% and 3.6%, respectively, in 2015. Cardiovascular disease comprises conditions affecting the heart, the most common of which is coronary artery disease.

High blood pressure, high cholesterol, and smoking are major risk factors for heart disease. In addition to smoking, unhealthy behaviors such as poor diet — specifically eating a diet high in saturated fats, trans fat, and cholesterol — and lack of physical activity and excessive drinking also increase a person’s risk of developing a cardiovascular disease.

About 17.3% of adult Americans smoke, 29.0% are obese, and 23.6% don’t exercise regularly. In nine of the 10 states with the highest shares of adults with heart disease, at least 30.1% of adults are obese. The majority of states with the most heart disease have some of the largest percentage of adults who report physical inactivity and smoking.

Additionally, eight of those 10 states are also among the states with the highest premature mortality rates. Life expectancy is one of the most telling and often cited measures of the health of a given population — this is the least healthy city in every state.

Socioeconomic factors may play a role as people with low incomes may struggle to get access to health care, buy healthy food, or prioritize exercise. In eight of the 10 states with the highest shares of adults with cardiovascular disease household incomes are among the 10 lowest in the country. The median annual household income in these states is between $45,000 and $56,000, compared to a national median of over $65,000.

Click here to see the states where the most people have heart disease.
Click here to read our detailed methodology.