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The States With the Most Heart Disease

24/7 Tempo logo 24/7 Tempo 3/13/2019 Hristina Byrnes
a man standing in front of a monitor © shapecharge / Getty Images

One in every four deaths in the United States is caused by heart disease, or 610,000 deaths a year. Heart disease is by far the leading cause of death in the country.

On average, 6.9% of American adults have some form of major cardiovascular disease and 3.6% have suffered a heart attack. Cardiovascular disease comprises conditions affecting the heart, the most common of which are coronary artery disease, heart attack, and arrhythmia.

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.

Across populations, high rates of these factors can have an impact on the prevalence of heart disease, as is the case in some states across the country. Nine of the 10 states with the highest shares of adults with heart disease also have among the highest obesity, smoking, and inactivity rates among adults in the United States.

Eight of the 10 states with the highest shares of adults with heart disease also have among the highest poverty rates in the country. The median annual household income in these states is between $43,000 and $55,000, compared to a 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 are 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 One-Year American Community Survey.

a yellow boat docked next to a body of water: > Adults with cardiovascular disease: 6.9% (tied with Arizona)
> Adults who've had heart attack: 3.3% (14th lowest)
> Population: 6,052,177
Maryland has the highest median household income in the United States and among the lowest adult smoking rates -- factors that would be more likely to result in healthier outcomes. But the adult obesity rate as well as the share of adults who do not engage in physical activity -- two risk factors for heart disease -- are close to their corresponding national average. This may explain why Maryland's percentage of adults living with heart disease equals the national average of 6.9%.
ALSO READ: This is the divorce capital in Maryland © SeanPavonePhoto / Getty Images

> Adults with cardiovascular disease: 6.9% (tied with Arizona)
> Adults who've had heart attack: 3.3% (14th lowest)
> Population: 6,052,177

Maryland has the highest median household income in the United States and among the lowest adult smoking rates -- factors that would be more likely to result in healthier outcomes. But the adult obesity rate as well as the share of adults who do not engage in physical activity -- two risk factors for heart disease -- are close to their corresponding national average. This may explain why Maryland's percentage of adults living with heart disease equals the national average of 6.9%.

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25. Maryland

> Adults with cardiovascular disease: 6.9% (tied with Arizona)

> Adults who've had heart attack: 3.3% (14th lowest)

> Population: 6,052,177

Maryland has the highest median household income in the United States and among the lowest adult smoking rates -- factors that would be more likely to result in healthier outcomes. But the adult obesity rate as well as the share of adults who do not engage in physical activity -- two risk factors for heart disease -- are close to their corresponding national average. This may explain why Maryland's percentage of adults living with heart disease equals the national average of 6.9%.

a large body of water with a city in the background: > Adults with cardiovascular disease: 7.0%
> Adults who've had heart attack: 3.6% (25th highest)
> Population: 2,088,070
Several negative health outcomes may contribute to New Mexico's above average share of adults with a cardiovascular disease. Socioeconomic status may also explain why New Mexico is on the list of states with the highest incidence of heart disease. New Mexico is among the poorest states in the country -- it has the second highest poverty rate and the highest share of households living in extreme poverty. People living in poverty are not only less likely to have access to health care and healthy diets, as well as tend to smoke more, but also to take longer to handle stressful situations, which can increase the risk of heart disease.
ALSO READ: This is the best city to live in New Mexico © ferrantraite / Getty Images

> Adults with cardiovascular disease: 7.0%
> Adults who've had heart attack: 3.6% (25th highest)
> Population: 2,088,070

Several negative health outcomes may contribute to New Mexico's above average share of adults with a cardiovascular disease. Socioeconomic status may also explain why New Mexico is on the list of states with the highest incidence of heart disease. New Mexico is among the poorest states in the country -- it has the second highest poverty rate and the highest share of households living in extreme poverty. People living in poverty are not only less likely to have access to health care and healthy diets, as well as tend to smoke more, but also to take longer to handle stressful situations, which can increase the risk of heart disease.

ALSO READ: This is the best city to live in New Mexico

24. New Mexico

> Adults with cardiovascular disease: 7.0%

> Adults who've had heart attack: 3.6% (25th highest)

> Population: 2,088,070

Several negative health outcomes may contribute to New Mexico's above-average share of adults with a cardiovascular disease. Socioeconomic status may also explain why New Mexico is on the list of states with the highest incidence of heart disease. New Mexico is among the poorest states in the country -- it has the second highest poverty rate and the highest share of households living in extreme poverty. People living in poverty are not only less likely to have access to health care and healthy diets, as well as tend to smoke more, but also to take longer to handle stressful situations, which can increase the risk of heart disease.

a large building with a mountain in the background: > Population: 119,440 > Physically active adults: 82.3% (top 25%) > Population with access to exercise locations: 91.3% (top 25%) > Obesity rate: 24.2% (bottom 25%) > Adults in fair or poor health: 11.8% (bottom 10%) © Jeff Zehnder / Shutterstock.com > Population: 119,440 > Physically active adults: 82.3% (top 25%) > Population with access to exercise locations: 91.3% (top 25%) > Obesity rate: 24.2% (bottom 25%) > Adults in fair or poor health: 11.8% (bottom 10%)

23. Kansas

> Adults with cardiovascular disease: 7.0%

> Adults who've had heart attack: 3.5% (23rd lowest)

> Population: 2,913,123

No other state in the country has a higher share of adults living with high blood pressure, a known risk factor of heart disease. High blood pressure can cause damage to the arteries; it can cause the heart to work too hard, which may enlarge and thicken the heart, putting further strain on it; and eventually it can cause heart failure. Kansas is among the states with the highest prevalence of high cholesterol and obesity among adults, both of which are also known to increase the risk of cardiovascular disease.

a large body of water with a city in the background: > Adults with cardiovascular disease: 7.2%
> Adults who've had heart attack: 3.9% (21st highest)
> Population: 869,666
The reasons behind South Dakota's higher than average prevalence of heart disease are not always very clear. Yet, heart disease is the leading cause of death in South Dakota, responsible for more than a fifth of deaths in 2015. Of all major factors increasing the risk of heart disease, only one is among the highest in the country. Almost a fifth of the state's adult population smokes, well above the national rate of 17.1%.
ALSO READ: This is the best city to live in South Dakota © EunikaSopotnicka / Getty Images

> Adults with cardiovascular disease: 7.2%
> Adults who've had heart attack: 3.9% (21st highest)
> Population: 869,666

The reasons behind South Dakota's higher than average prevalence of heart disease are not always very clear. Yet, heart disease is the leading cause of death in South Dakota, responsible for more than a fifth of deaths in 2015. Of all major factors increasing the risk of heart disease, only one is among the highest in the country. Almost a fifth of the state's adult population smokes, well above the national rate of 17.1%.

ALSO READ: This is the best city to live in South Dakota

22. South Dakota

> Adults with cardiovascular disease: 7.2%

> Adults who've had heart attack: 3.9% (21st highest)

> Population: 869,666

The reasons behind South Dakota's higher-than-average prevalence of heart disease are not always very clear. Yet, heart disease is the leading cause of death in South Dakota, responsible for more than a fifth of deaths in 2015. Of all major factors increasing the state's risk of heart disease, only one is among the highest in the country. Almost a fifth of the state's adult population smokes, well above the national rate of 17.1%.

a small clock tower in the middle of a field: > Libraries per 100,000 residents: 24.3 > Public libraries: 58 > Colleges and universities: 5 > Adults with high school diploma: 94.9% ALSO READ: Best Prison Movies of All Time © tzm23 / Shutterstock.com > Libraries per 100,000 residents: 24.3 > Public libraries: 58 > Colleges and universities: 5 > Adults with high school diploma: 94.9% ALSO READ: Best Prison Movies of All Time

21. Illinois

> Adults with cardiovascular disease: 7.3%

> Adults who've had heart attack: 3.5% (23rd lowest)

> Population: 12,802,023

Many of the factors that increase the risk of heart disease, such as obesity and inactivity, are similar in Illinois to the national average. Two, however, stand out -- drinking and heavy-weight adults. Similarly, 20.3% of adults report binge drinking, compared to 17.4% nationwide.

a castle surrounded by a body of water: > Women's earnings as pct. of men's: 82.1% > Bachelor's degree attainment: 29.1% male, 34.8% female > Poverty rate: 10.4% male, 11.7% female > Industry with the worst pay gap: Agriculture, forestry, fishing and hunting, and mining (60.4% pay gap) ALSO READ: Largest Industry in Each State © jtstewartphoto / iStock > Women's earnings as pct. of men's: 82.1% > Bachelor's degree attainment: 29.1% male, 34.8% female > Poverty rate: 10.4% male, 11.7% female > Industry with the worst pay gap: Agriculture, forestry, fishing and hunting, and mining (60.4% pay gap) ALSO READ: Largest Industry in Each State

20. Maine

> Adults with cardiovascular disease: 7.5%

> Adults who've had heart attack: 4.3% (tied, 11th highest)

> Population: 1,335,907

About 5.8% of adult residents in Maine have been told by a doctor they have had a heart attack, the sixth highest share of all states. Maine is also among the 10 states with the highest share of adults reporting coronary artery disease (damage to the major blood vessels) or heart attack. Another risk factor is depression, which has been linked to heart conditions. It brings about behaviors that contribute to cardiovascular disease such as sedentary lifestyle, smoking, drinking, and eating unhealthy foods. Maine has the second highest rate of adults being told they have some form of depression.

a large body of water with a city in the background: > Adults with cardiovascular disease: 7.6%
> Adults who've had heart attack: 4.1% (tied, 14th highest)
> Population: 20,984,400
The adult smoking and obesity rates in Florida are just below the national rates, and the shares of adults reporting excessive drinking and not exercising are similar to national averages. The share of adult residents who do not have a doctor or a health care provider is high. At 28.0%, it is the ninth highest in the country. About 12.9% of adults do not have any health insurance. Uninsured people receive less care for conditions such as high blood pressure that can increase the risk of heart disease. The cost of health care can be too high if paid out of pocket. © Javier_Art_Photography / Getty Images

> Adults with cardiovascular disease: 7.6%
> Adults who've had heart attack: 4.1% (tied, 14th highest)
> Population: 20,984,400

The adult smoking and obesity rates in Florida are just below the national rates, and the shares of adults reporting excessive drinking and not exercising are similar to national averages. The share of adult residents who do not have a doctor or a health care provider is high. At 28.0%, it is the ninth highest in the country. About 12.9% of adults do not have any health insurance. Uninsured people receive less care for conditions such as high blood pressure that can increase the risk of heart disease. The cost of health care can be too high if paid out of pocket.

19. Florida

> Adults with cardiovascular disease: 7.6%

> Adults who've had heart attack: 4.1% (tied, 14th highest)

> Population: 20,984,400

The adult smoking and obesity rates in Florida are just below the national rates, and the shares of adults reporting excessive drinking and not exercising are similar to national averages. The share of adult residents who do not have a doctor or a health care provider is high. At 28.0%, it is the ninth highest in the country. About 12.9% of adults do not have any health insurance. Uninsured people receive less care for conditions such as high blood pressure that can increase the risk of heart disease. The cost of health care can be too high if paid out of pocket.

a large white house: > Adults with cardiovascular disease: 7.7%
> Adults who've had heart attack: 4.0% (tied, 17th highest)
> Population: 9,962,311
Michigan is among the states with the highest incidence of stroke, which occurs when blood vessels to the brain are clogged or burst. The high smoking and excessive drinking rates among adults in the state may also help explain the state's high share of cardiovascular disease. So can the prevalence of high total cholesterol and hypertension -- more than a third of adults residents live with either or both.
ALSO READ: This is the worst city to live in Michigan © smontgom65 / iStock

> Adults with cardiovascular disease: 7.7%
> Adults who've had heart attack: 4.0% (tied, 17th highest)
> Population: 9,962,311

Michigan is among the states with the highest incidence of stroke, which occurs when blood vessels to the brain are clogged or burst. The high smoking and excessive drinking rates among adults in the state may also help explain the state's high share of cardiovascular disease. So can the prevalence of high total cholesterol and hypertension -- more than a third of adults residents live with either or both.

ALSO READ: This is the worst city to live in Michigan

18. Michigan

> Adults with cardiovascular disease: 7.7%

> Adults who've had heart attack: 4.0% (tied, 17th highest)

> Population: 9,962,311

Michigan is among the states with the highest incidence of stroke, which occurs when blood vessels to the brain are clogged or burst. The high smoking and excessive drinking rates among adults in the state may also help explain the state's high share of cardiovascular disease. So can the prevalence of high total cholesterol and hypertension -- more than a third of adults residents live with either or both.

a castle with a clock at the top of a brick building with Delaware Legislative Hall in the background: > Women's earnings as pct. of men's: 85.6% > Bachelor's degree attainment: 30.9% male, 32.0% female > Poverty rate: 12.0% male, 15.1% female > Industry with the worst pay gap: Information (54.9% pay gap) © Jon Bilous / Shutterstock.com > Women's earnings as pct. of men's: 85.6% > Bachelor's degree attainment: 30.9% male, 32.0% female > Poverty rate: 12.0% male, 15.1% female > Industry with the worst pay gap: Information (54.9% pay gap)

17. Delaware

> Adults with cardiovascular disease: 7.7%

> Adults who've had heart attack: 4.0% (tied, 17th highest)

> Population: 961,939

Unhealthy behaviors such as lack of physical activity may be contributing to Delaware's relatively high share of adults living with heart disease. In Delaware, 53.7% of adults don't exercise enough in a week, compared to 49.8% of adults nationwide. About a third of people have not participated in any physical activities in over a month, more than the 25.7% of adults across the country. The high inactivity rate has likely contributed to the high incidence of high cholesterol and high blood pressure in the state, at sixth and fourth of all states, respectively.

a bench in front of a building: > Most expensive college: Drexel University > Annual net price: $39,021 > Statewide 4-yr public university tuition: $13,540 > Drexel University admission rate: 74.6% > Total state student aid spending per student: $628.98 (21st highest) ALSO READ: Biggest One-Hit Wonders © tupungato / iStock > Most expensive college: Drexel University > Annual net price: $39,021 > Statewide 4-yr public university tuition: $13,540 > Drexel University admission rate: 74.6% > Total state student aid spending per student: $628.98 (21st highest) ALSO READ: Biggest One-Hit Wonders

16. Pennsylvania

> Adults with cardiovascular disease: 7.8%

> Adults who've had heart attack: 4.1% (tied, 14th highest)

> Population: 12,805,537

Pennsylvania has the ninth highest share of adults who have been told by a doctor they have angina -- severe chest pain as a result of restricted blood supply to the heart -- or coronary heart disease, of which angina can be a symptom. The share of adults who were told they have had a stroke is also high at 3.8%, the 10th highest of all states and above the national share of 3.0%. Even though contributing factors to heart disease do not vary greatly from the average nationwide, heart disease is still the top killer in the state with more than 31,000 deaths in 2014.

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15. Texas

> Adults with cardiovascular disease: 7.8%

> Adults who've had heart attack: 4.2% (13th highest)

> Population: 28,304,596

About a third of adult Texans do not have a personal doctor or health care provider, the second highest share in the country. Not having a personal doctor may result in fewer doctor visits and checkups that can potentially detect risk factors of heart conditions such as chronic high cholesterol or hypertension. About 17.3% of adults in the state are uninsured, the highest uninsured rate of all states. Lack of physical activity may also help explain the state's high share of heart disease. Texas has the highest share of adult residents who do not exercise for the recommended 150 minutes per week (58.1%) and the fifth highest share of adults who do not engage in physical activity at least once a month (32.1%.)

an empty park bench next to a tree: > Most expensive college: Oberlin College > Annual net price: $42,105 > Statewide 4-yr public university tuition: $9,772 > Oberlin College admission rate: 28.0% > Total state student aid spending per student: $191.26 (11th lowest) © chicabrandita / Flickr > Most expensive college: Oberlin College > Annual net price: $42,105 > Statewide 4-yr public university tuition: $9,772 > Oberlin College admission rate: 28.0% > Total state student aid spending per student: $191.26 (11th lowest)

14. Ohio

> Adults with cardiovascular disease: 7.9%

> Adults who've had heart attack: 4.1% (14th highest)

> Population: 11,658,609

Negative health outcomes such as obesity as well as poor health habits such as not exercising and smoking may help explain Ohio's high cardiovascular disease rate among adults -- all mentioned factors are among the highest in the country. About 22.5% of adults are regular smokers, the sixth highest smoking rate of all states and above the national rate of 17.0%. A bad diet can also be a contributing factor to heart disease, especially one that lacks fruits and vegetables. Ohio has the third highest share of adults who do not eat the recommended amount of fruits and vegetables in a day.

a car parked on the side of a building: > Population decrease due to migration, 2010-2017: -8,791 > Population change, 2010-2017: +9.1% (177,799 to 193,893) > Natural growth, 2010-2017: 30,768 births, 7,184 deaths > Median home value: $151,500 © jacksonvillenc.gov > Population decrease due to migration, 2010-2017: -8,791 > Population change, 2010-2017: +9.1% (177,799 to 193,893) > Natural growth, 2010-2017: 30,768 births, 7,184 deaths > Median home value: $151,500

13. North Carolina

> Adults with cardiovascular disease: 7.9%

> Adults who've had heart attack: 3.7% (22nd highest)

> Population: 10,273,419

One possible reason for the state's high prevalence of cardiovascular disease may be lack of health insurance. More than one in 10 people do not have health insurance, the 10th highest uninsured rate of all states and above the national rate of 8.7%. Having no insurance may discourage people from going to the doctor even when they exhibit possible symptoms because of the expense. Further, without annual checkups, high cholesterol levels may not be detected -- high cholesterol can increase the risk of heart disease. More than a third of adults in North Carolina have high cholesterol, more than the national average of 32.3%.

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12. South Carolina

> Adults with cardiovascular disease: 8.0%

> Adults who've had heart attack: 4.0% (17th highest)

> Population: 5,024,369

Obesity, lack of health insurance, and poverty may lead to negative health outcomes, including heart disease. In South Carolina, all three factors rank among the 10 highest of all states. Also, 13.4% of adults in the state have been told they are diabetic, the fifth highest share of all states. Diabetics are more likely to develop heart disease as they are more likely to develop certain risk factors of heart disease such as high blood pressure and high cholesterol. This may also explain why South Carolina is among the states with the largest shares of heart disease.

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11. Georgia

> Adults with cardiovascular disease: 8.6%

> Adults who've had heart attack: 4.3% (tied, 11th highest)

> Population: 10,429,379

Typical heart disease risk factors such as obesity and smoking rates among Georgia's adults do not vary greatly from the national average. But the lack of health coverage and number of physicians per 100,000 people as a whole do vary and are worse than the national average, and that may increase the risk of cardiovascular disease. Georgia has the 10th lowest concentration of primary care doctors per capita than all other states and the fifth lowest concentration of dentists per capita. Dentists can detect heart disease because one of the signs is swollen and bleeding gums.

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10. Indiana

> Adults with cardiovascular disease: 8.8%

> Adults who've had heart attack: 4.7% (7th highest)

> Population: 6,666,818

Indiana has the 10th highest share of adults living with heart disease. Some possible factors include the prevalence of depression and diabetes among the state population. The state's adult obesity rate is the 10th highest in the country. The shares of people who smoke and don't exercise are also among the highest. All of these are major factors contributing to cardiovascular problems.

a person riding a horse in front of a body of water: Only about one in four Americans read a book in the last year, according to the Pew Research Center. That statistic includes e-books and audiobooks, not just the printed word. While literacy is a basic goal of education systems worldwide, instilling the desire to read is more complicated. The vast majority of American adults are able to read and write fluently in English, yet far fewer actually use their abilities to read anything beyond the messages on their smartphones and work emails. The value of reading a novel can be debated, although studies have shown that reading improves intelligence, enhances memory, expands vocabulary, and reduces stress. While the shift to digital books is still changing the publishing industry, it is clear that continuing to embrace reading is important for our nation’s youth. 24/7 Wall St. reviewed a number of measures associated with literacy to determine in which American metropolitan areas the population is most likely to read books on a regular basis. The measures include the presence of public libraries, residents’ education level, and the presence of higher-learning institutions. The best-read cities range from small cities like Ithaca, New York to major metropolitan centers like New York CIty and Boston. Based on our index, the Kansas City, MO-KS area is one of the most well-read in the country. According to Pew’s research, households with higher incomes are significantly more likely to read books on a regular basis. In most of the metropolitan areas to make the list of the best-read cities, the typical household income well exceeds the national median household income. In Kansas City, the typical household earns $61,385 a year, well above the national annual median household income of $57,617. © tomofbluesprings / iStock Only about one in four Americans read a book in the last year, according to the Pew Research Center. That statistic includes e-books and audiobooks, not just the printed word. While literacy is a basic goal of education systems worldwide, instilling the desire to read is more complicated. The vast majority of American adults are able to read and write fluently in English, yet far fewer actually use their abilities to read anything beyond the messages on their smartphones and work emails. The value of reading a novel can be debated, although studies have shown that reading improves intelligence, enhances memory, expands vocabulary, and reduces stress. While the shift to digital books is still changing the publishing industry, it is clear that continuing to embrace reading is important for our nation’s youth. 24/7 Wall St. reviewed a number of measures associated with literacy to determine in which American metropolitan areas the population is most likely to read books on a regular basis. The measures include the presence of public libraries, residents’ education level, and the presence of higher-learning institutions. The best-read cities range from small cities like Ithaca, New York to major metropolitan centers like New York CIty and Boston. Based on our index, the Kansas City, MO-KS area is one of the most well-read in the country. According to Pew’s research, households with higher incomes are significantly more likely to read books on a regular basis. In most of the metropolitan areas to make the list of the best-read cities, the typical household income well exceeds the national median household income. In Kansas City, the typical household earns $61,385 a year, well above the national annual median household income of $57,617.

9. Missouri

> Adults with cardiovascular disease: 9.2%

> Adults who've had heart attack: 4.5% (10th highest)

> Population: 6,113,532

Unhealthy behaviors such as smoking and sedentary lifestyles are prevalent in Missouri. The state has the seventh highest share of smoking adults at 22.1%, compared to a national smoking rate of 17.0%. Also, Missouri has the 11th highest share of inactive adults and the 12th highest adult obesity rate. Obesity can increase the risk of stroke -- inflammation caused by the excess fatty tissue can restrict blood flow, leading to a stroke. In Missouri, 4.2% of adults have had a stroke, the ninth highest share of all states and above the national share of 3.0%.

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8. Arkansas

> Adults with cardiovascular disease: 9.3%

> Adults who've had heart attack: 4.6% (tied, 8th highest)

> Population: 3,004,279

Arkansas ranks highly in two major behaviors that can significantly increase the risk of cardiovascular disease. The state has the second highest share of adults who do not engage in physical activity -- about a third compared to 23.0% nationally -- and the third highest share of adults who smoke at 23.6%, compared to a national smoking rate of 17.0%. At 24.5%, no other state has a higher share of adults who report being in fair or poor health, compared to 16.0% of adults nationwide.

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7. Oklahoma

> Adults with cardiovascular disease: 9.4%

> Adults who've had heart attack: 5.4% (3rd highest)

> Population: 3,930,864

Several factors may explain the high share of adults living with heart disease in Oklahoma. One of them is obesity. Of adults in the state, 36.5% are obese, the third highest adult obesity rate of all states. Another factor is sedentary lifestyles. The physical inactivity rate, both weekly and monthly, is among the highest in the country. About 57.5% of adult residents do not exercise enough a week, the second highest share of all states and above the corresponding national rate of 49.8%. And 32.4% of adults do not exercise at all during a month, the fourth highest share in the country, and compared to a national rate of 25.7%. Lack of insurance may also be a factor as 14.2% of adult residents are uninsured, the second highest uninsured rate after only Texas. Nationwide, 8.7% of adults are uninsured.

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6. Louisiana

> Adults with cardiovascular disease: 9.7%

> Adults who've had heart attack: 4.9% (6th highest)

> Population: 4,684,333

Poor diet, especially one that lacks fruits and vegetables that are rich in vitamins, minerals, and antioxidants, is a known risk factor for heart disease. And Louisiana has the highest share of adults who do not eat fruits and vegetables regularly. Smoking and sedentary lifestyles, two other major risk factors of heart disease, are also prevalent in the state. The state has the third highest share of obese adults in the country at 34.7%, compared to 28.0% nationally.

a view of a city: > Adults with cardiovascular disease: 9.8% (tied with Tennessee)
> Adults who've had heart attack: 4.6% (8th highest)
> Population: 4,874,747
In Alabama, 4.9% of adults have had a stroke, the second highest share of all states and well above the 3.0% of adults nationwide. The state also has a relatively high share of adults living with diabetes. Diabetes may increase the risk of developing heart disease because diabetics are more likely to develop high blood pressure, abnormal cholesterol levels, and they tend to be less physically active -- all factors that elevate the risk of heart disease. Alabama has among the highest adult obesity and inactivity rates, both of which, too, can increase the risk of heart disease. © SeanPavonePhoto / Getty Images

> Adults with cardiovascular disease: 9.8% (tied with Tennessee)
> Adults who've had heart attack: 4.6% (8th highest)
> Population: 4,874,747

In Alabama, 4.9% of adults have had a stroke, the second highest share of all states and well above the 3.0% of adults nationwide. The state also has a relatively high share of adults living with diabetes. Diabetes may increase the risk of developing heart disease because diabetics are more likely to develop high blood pressure, abnormal cholesterol levels, and they tend to be less physically active -- all factors that elevate the risk of heart disease. Alabama has among the highest adult obesity and inactivity rates, both of which, too, can increase the risk of heart disease.

5. Alabama

> Adults with cardiovascular disease: 9.8% (tied with Tennessee)

> Adults who've had heart attack: 4.6% (8th highest)

> Population: 4,874,747

In Alabama, 4.9% of adults have had a stroke, the second highest share of all states and well above the 3.0% of adults nationwide. The state also has a relatively high share of adults living with diabetes. Diabetes may increase the risk of developing heart disease because diabetics are more likely to develop high blood pressure, abnormal cholesterol levels, and they tend to be less physically active -- all factors that elevate the risk of heart disease. Alabama has among the highest adult obesity and inactivity rates, both of which, too, can increase the risk of heart disease.

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4. Tennessee

> Adults with cardiovascular disease: 9.8%

> Adults who've had heart attack: 5.3% (4th highest)

> Population: 6,715,984

Diabetes, sedentary lifestyles, obesity, and smoking -- all major risk factors for heart disease -- are very common among adults in Tennessee. About 13.1% of adults have been diagnosed with diabetes, the sixth highest rate in the country; 30.1% don't exercise, the third highest share in the country, compared to a national average of 23.0%; and 32.4% of adults are obese, the eighth highest share in the United States.

a large body of water with a city in the background: > Married population: 44.8%
> 2017 divorce rate: 2.9 per 1,000 residents (16th lowest)
> 2017 marriage rate: 6.7 per 1,000 residents (24th lowest) © SeanPavonePhoto / Getty Images

> Married population: 44.8%
> 2017 divorce rate: 2.9 per 1,000 residents (16th lowest)
> 2017 marriage rate: 6.7 per 1,000 residents (24th lowest)

3. Mississippi

> Adults with cardiovascular disease: 10.1%

> Adults who've had heart attack: 5.1% (5th highest)

> Population: 2,984,100

More than one in 10 adults in Mississippi are living with cardiovascular disease, the third highest share of all states. The state has a relatively high adult smoking rate and the second highest obesity rate of all states. In addition, the state has relatively few doctors, another factor that may contribute to the state's high heart disease rate. There are 53.2 primary care physicians per 100,000 people, the lowest concentration, compared to an average of 75.8 per 100,000 across the country. Poverty is another risk factor for heart disease, as those living in poverty tend to have less access to health care and healthy behaviors and are also more likely to smoke. This may help explain the high rate of heart disease in Mississippi.

a group of people in a garden: > Fastest-growing metropolitan area: Bowling Green > 2010-2017 pop. growth: +9.7% (+15,526) > 2010-2017 pop. growth, Kentucky: +2.4% (+106,241) > Feb. 2018 unemployment: 3.6% (State: 4.1%) > Largest driver of growth: Domestic migration © https://www.flickr.com/photos/joeshlabotnik/ > Fastest-growing metropolitan area: Bowling Green > 2010-2017 pop. growth: +9.7% (+15,526) > 2010-2017 pop. growth, Kentucky: +2.4% (+106,241) > Feb. 2018 unemployment: 3.6% (State: 4.1%) > Largest driver of growth: Domestic migration

2. Kentucky

> Adults with cardiovascular disease: 10.6%

> Adults who've had heart attack: 5.8% (tied, the highest)

> Population: 4,454,189

Diabetes, obesity, lack of physical activity -- all of these risk factors for cardiovascular disease are common in Kentucky. About 34.4% of adults do not exercise even over a month, the highest inactivity rate in the country and above the corresponding rate nationwide of 25.7%. In addition, Kentucky has the second highest share of adults smoking -- smoking has been known to increase the risk of heart disease by damaging blood cells and the structure of the heart.

a long bridge over a body of water: > Adults with cardiovascular disease: 11.6%
> Adults who've had heart attack: 5.8% (the highest)
> Population: 1,815,857
In West Virginia, 11.6% of adult have heart disease, the highest share of all states. Many of the major risk factors of heart disease are very common in West Virginia. The state has the third highest share of adults with high blood pressure, the largest share of adults with high cholesterol, the highest share of smokers, as well as the highest obesity rate among adults. © Sean Pavone / Getty Images

> Adults with cardiovascular disease: 11.6%
> Adults who've had heart attack: 5.8% (the highest)
> Population: 1,815,857

In West Virginia, 11.6% of adult have heart disease, the highest share of all states. Many of the major risk factors of heart disease are very common in West Virginia. The state has the third highest share of adults with high blood pressure, the largest share of adults with high cholesterol, the highest share of smokers, as well as the highest obesity rate among adults.

1. West Virginia

> Adults with cardiovascular disease: 11.6%

> Adults who've had heart attack: 5.8% (the highest)

> Population: 1,815,857

In West Virginia, 11.6% of adults have heart disease, the highest share of all states. Many of the major risk factors of heart disease are very common in West Virginia. The state has the third highest share of adults with high blood pressure, the largest share of adults with high cholesterol, the highest share of smokers, as well as the highest obesity rate among adults.

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