Health Insurance
Most Heart-Healthy States in the U.S.
February is American Heart Month. That makes it the perfect time to raise awareness that heart disease is the leading cause of death in the U.S., based on the most recent year for which full data is available.
Proper self-care is a critical part of keeping your heart healthy, especially during such challenging times. Those with cardiovascular health challenges experience an increased risk of serious illness from COVID-19.
In honor of American Heart Month, ValuePenguin took an in-depth look at coronary heart disease rates among adults. Researchers then age-adjusted the data to rank the most heart-healthy states in the U.S. Researchers also culled additional national and state data, from heart disease deaths to heart-healthy lifestyles to high cholesterol.
- Key findings
- Nearly 1 in 20 U.S. adults has been diagnosed with coronary heart disease
- Utah is the most heart-healthy state in the U.S.
- West Virginia is the least heart-healthy state in the U.S.
- Full rankings: Most heart-healthy states in the U.S.
- Minnesota has the lowest rate of heart disease deaths among middle-age adults
- Other ways to measure heart health: Lifestyle, high cholesterol
- 4 tips to protect your health, finances and family
- How COVID-19 affects the heart
- Methodology
Key findings
- 4.6% of U.S. adults — or nearly 1 in 20 — have been diagnosed with coronary heart disease, according to 2019 data from the National Center for Health Statistics. In 2020, heart disease killed nearly 700,000 U.S. adults, making it the leading cause of death.
- Utah has the lowest coronary heart disease rate (2.4%) of any U.S. state. ValuePenguin researchers created an age-weighted score to account for states where young people are more likely to have heart disease. Even with the Beehive State having the third-highest rate of under-65 adults (84.6%), it remains the most heart-healthy state in the U.S.
- West Virginia has far and away the highest coronary heart disease rate (8.3%), even after researchers factored in its older population. The opposite of Utah, the Mountain State has the third-lowest rate of under-65 adults (75.7%). But its age-weighted score makes it the least heart-healthy state at 6.3%.
- Minnesota has the lowest rate of heart disease deaths per 100,000 adults ages 45 to 64. The North Star State reports 71.5 deaths per 100,000 people ages 45 to 64, compared with the state at the other end of the spectrum — Mississippi — at 216.7. Compared to the main metric, Minnesota is tied as the seventh most heart-healthy state, while Mississippi is 43rd.
Nearly 1 in 20 U.S. adults has been diagnosed with coronary heart disease
Despite the emergence of COVID-19, heart disease remained the most common cause of death in the U.S. in 2020. According to 2020 data from the National Center for Health Statistics (NCHS), death certificates indicated that heart disease killed close to 700,000 Americans that year.
Separate survey results from the NCHS in 2019 showed that 4.6% of American adults have received a coronary heart disease diagnosis. Coronary heart disease, also called coronary artery disease or ischemic heart disease, is the most common type of heart disease in the U.S. In 2019, nearly 361,000 Americans died due to this type of cardiovascular disease.
Overall, the deaths caused by heart disease and heart disease-related complications are numerous. Out of 100,000 American adults 35 and older:
- 52.4 die from acute myocardial infarction (heart attack)
- 177.6 die from heart failure
- 317.4 die from heart disease
- 419.2 die from cardiovascular disease
Source: Centers for Disease Control and Prevention (CDC). Interactive Atlas of Heart Disease and Stroke. Accessed on Jan. 14, 2022.
Many American adults also have risk factors that put them at high risk for developing heart disease, including:
- 38.1% with high total cholesterol (20 and older)
- 42.4% who are obese (20 and older)
- 25.4% who are physically inactive (18 and older)
In addition to potential lifestyle changes, Americans can lower some heart disease risk factors with proper medication. However, many aren’t taking advantage of this assistance. For example, just 54.5% of people who would benefit from cholesterol-lowering drugs are taking them.
Utah is the most heart-healthy state in the U.S.
Heart health figures vary across the U.S., with certain states struggling more than others. Residents of Utah, for example, experience coronary heart disease at a lower rate (2.4%) than any other state.
ValuePenguin used an age-adjusted approach to get a more nuanced look. The likelihood of developing coronary heart disease rises with age, and some states have older populations than others. So researchers ranked states by weighting the rate of coronary heart disease against the proportion of the adult population (18 and older) who are also younger than 65. If a state presumably has fewer younger adults (younger than 65) with heart disease, it fares better in our calculations.
In addition to being the state with the youngest population, other factors may contribute to Utah’s being the most heart-healthy state in the U.S. The state’s efforts to combat the disease, for example, may play a role.
The Utah Department of Health’s Bureau of Health Promotion created a program that targets heart disease risk factors and other health challenges. The program encourages nutritious food choices and physical activity among residents. Healthy Environments Active Living (or HEAL, as the program is called) also aims to improve quality health care access for those already at risk for developing heart disease, such as people with high blood pressure and those struggling with obesity.
After Utah, the rest of the top five heart-healthy states in the U.S. are as follows:
- The District of Columbia follows Utah closely with a coronary heart disease rate of 2.5% and an age-weighted score of 2.1%.
- Colorado has a coronary heart disease rate of 2.7%, with an age-weighted score of 2.2%.
- Hawaii comes in fourth on the heart-healthy-state list with a heart disease rate of 3.1% and an age-weighted score of 2.4%.
- Alaska and California round out the top five heart-healthy states in a tie. Alaska has a 3.1% rate of coronary heart disease, while California’s rate is 3.2%. But when you factor in age-weighted scores, both states tie at 2.6%.
West Virginia is the least heart-healthy state in the U.S.
West Virginia has the highest rate of coronary heart disease in the country, even after considering the state’s older population. Nearly a quarter of the state’s adults are older than 65. The state still comes in as the least heart-healthy state with a 6.3% age-weighted score.
Aside from the age of its population, other challenges contribute to the Mountain State’s heart-health struggles. West Virginia’s Department of Health & Human Resources cites the prevalence of obesity (highest in the nation at 37.7%, based on 2018 data), lack of health care access — though lower than the U.S. average — tobacco use and low physical activity levels as some of the risk factors affecting the health of the state’s residents.
- Kentucky and Arkansas are tied as the second least heart-healthy states in the U.S. Kentucky has a 6.3% rate of coronary heart disease while Arkansas has a rate of 6.4%. Both states, however, have an age-weighted score of 5%.
- Louisiana is next on the list of least heart-healthy states. Residents have a 6.0% rate of coronary heart disease with an age-weighted score of 4.8%.
- Alabama holds the final spot in the bottom five heart-healthy states. The state’s coronary heart disease rate is 6.1%, and its age-weighted score is 4.8%.
Full rankings: Most heart-healthy states in the U.S.
States with the lowest coronary heart disease rates
Rank | State | Coronary heart disease rate among adults 18 and older | Percentage of adult population younger than 65 | Age-weighted score for coronary heart disease among adults |
|---|---|---|---|---|
| 1 | Utah | 2.4% | 84.6% | 2.0% |
| 2 | District of Columbia | 2.5% | 85.3% | 2.1% |
| 3 | Colorado | 2.7% | 82.2% | 2.2% |
| 4 | Hawaii | 3.1% | 77.3% | 2.4% |
| 5 | Alaska | 3.1% | 85.1% | 2.6% |
| 5 | California | 3.2% | 81.9% | 2.6% |
| 7 | Illinois | 3.4% | 80.3% | 2.7% |
| 7 | Minnesota | 3.4% | 79.9% | 2.7% |
| 7 | New Mexico | 3.4% | 78.0% | 2.7% |
| 10 | Massachusetts | 3.5% | 79.8% | 2.8% |
| 10 | Vermont | 3.6% | 76.9% | 2.8% |
| 12 | Connecticut | 3.7% | 78.8% | 2.9% |
Source: ValuePenguin analysis of Centers for Disease Control and Prevention and U.S. Census Bureau data.
Minnesota has the lowest rate of heart disease deaths among middle-age adults
Minnesota is tied for the seventh most heart-healthy state in the nation. However, even though it didn’t factor into the heart-healthy rankings above, the state has notable statistics worth discussing.
Among U.S. adults between the ages of 45 and 64, the North Star State has the lowest rate of heart disease deaths per 100,000 adults. Minnesota reports 71.5 deaths from heart disease per 100,000 adults in this age range. In contrast, Mississippi, which holds a spot in the bottom 10 heart-healthy states, reports 216.7 heart disease deaths per 100,000 adults.
Only four other states beyond Minnesota had fewer than 80 deaths per 100,000 people:
- Utah (75.9)
- Oregon (76.3)
- Massachusetts (76.8)
- Colorado (78.7)
At the other end of the spectrum, four states and the District of Columbia had more than 200 deaths from heart disease per 100,000 people ages 45 to 64:
- Mississippi (216.7)
- Oklahoma (210.6)
- Arkansas (207.2)
- District of Columbia (201.6)
- Alabama (201.2)
The District of Columbia figures are notable since the district simultaneously holds the No. 2 spot among the most heart-healthy states.
States with the lowest rates of heart disease deaths among middle-age adults
Rank | State | Heart disease death rate per 100,000, ages 45 to 64 | Rank | State | Heart disease death rate per 100,000, ages 45 to 64 |
|---|---|---|---|---|---|
| 1 | Minnesota | 71.5 | 27 | South Dakota | 115.3 |
| 2 | Utah | 75.9 | 28 | Kansas | 116.5 |
| 3 | Oregon | 76.3 | 29 | Hawaii | 117.4 |
| 4 | Massachusetts | 76.8 | 30 | Maryland | 120.6 |
| 5 | Colorado | 78.7 | 31 | Illinois | 120.8 |
| 6 | Connecticut | 86.7 | 32 | Pennsylvania | 121.7 |
| 7 | Washington | 87.2 | 33 | Iowa | 122.1 |
| 8 | California | 91.7 | 34 | North Carolina | 123.7 |
| 9 | Maine | 92.0 | 35 | Texas | 130.6 |
| 10 | New Hampshire | 92.5 | 36 | Michigan | 140.8 |
| 11 | Idaho | 93.5 | 37 | Indiana | 142.7 |
| 12 | Nebraska | 94.4 | 38 | Ohio | 144.9 |
Source: Centers for Disease Control and Prevention.
Other ways to measure heart health: Lifestyle, high cholesterol
Lifestyle
According to the Mayo Clinic, three of the most effective measures people can take to prevent heart disease are being physically active, maintaining a healthy weight (i.e., not being obese) and not smoking.
Based on these factors, ValuePenguin researchers used CDC and U.S. Census Bureau data to average the percentage of nonsmokers (ages 18 and older), active adults during leisure time (ages 20 and older) and those not designated as obese (ages 20 and older) to calculate which states have the most heart-healthy lifestyles.
States with the most heart-healthy lifestyles
Rank | State | Nonsmokers | Physically active leisure | Not obese | Average |
|---|---|---|---|---|---|
| 1 | Colorado | 84.4% | 85.4% | 77.7% | 82.5% |
| 2 | California | 87.1% | 82.6% | 75.9% | 81.9% |
| 2 | Utah | 89.7% | 83.1% | 72.8% | 81.9% |
| 4 | Washington | 86.8% | 84.0% | 71.5% | 80.8% |
| 5 | District of Columbia | 84.2% | 82.2% | 75.4% | 80.6% |
| 6 | Connecticut | 86.5% | 80.8% | 74.0% | 80.4% |
| 6 | Vermont | 85.4% | 82.6% | 73.1% | 80.4% |
| 8 | Hawaii | 85.1% | 80.8% | 75.0% | 80.3% |
| 8 | Massachusetts | 85.0% | 80.7% | 75.3% | 80.3% |
| 10 | New Mexico | 83.3% | 81.6% | 72.6% | 79.2% |
| 11 | Oregon | 83.2% | 83.4% | 70.8% | 79.1% |
| 12 | New Hampshire | 84.6% | 80.0% | 71.6% | 78.8% |
Source: ValuePenguin analysis of Centers for Disease Control and Prevention and U.S. Census Bureau data.
High cholesterol
Normal cholesterol levels can help the human body create healthy cells. However, high cholesterol can put you at a higher risk for developing heart disease and other heart-related complications like stroke or heart attack.
States with the lowest rates of high cholesterol
Rank | State | High cholesterol among adults screened in past 5 years, ages 18+ | Percentage of adult population younger than 65 | Age-weighted score of high cholesterol among screened adults |
|---|---|---|---|---|
| 1 | South Dakota | 30.2% | 78.4% | 23.7% |
| 2 | Minnesota | 30.1% | 79.9% | 24.1% |
| 2 | Vermont | 31.3% | 76.9% | 24.1% |
| 2 | District of Columbia | 28.3% | 85.3% | 24.1% |
| 5 | Montana | 31.7% | 76.8% | 24.3% |
| 6 | Utah | 29.8% | 84.6% | 25.2% |
| 7 | Idaho | 32.3% | 79.3% | 25.6% |
| 8 | Colorado | 31.3% | 82.2% | 25.7% |
| 8 | Hawaii | 33.2% | 77.3% | 25.7% |
| 8 | Washington | 31.9% | 80.6% | 25.7% |
| 11 | Connecticut | 32.7% | 78.8% | 25.8% |
| 11 | New Mexico | 33.0% | 78.0% | 25.8% |
Source: ValuePenguin analysis of Centers for Disease Control and Prevention and U.S. Census Bureau data.
4 tips to protect your health, finances and family
With heart disease being the leading cause of death in the U.S. — and so many American adults struggling with heart disease — it’s critical to do everything you can to protect your health, your finances and your family.
No. 1: Focus on risk factors that you can control
Older adults have a higher risk of developing heart disease. And while you can’t control your age or your family medical history, you can take steps to reduce heart disease risks in other ways.
Making healthy food choices, maintaining a healthy weight, exercising and controlling blood pressure and cholesterol levels are examples of factors you may be able to control. Other actions that could benefit you include managing stress levels, avoiding smoking and limiting alcohol consumption.
No. 2: Make health care a priority
Routine health care screenings can help you detect heart disease risk factors. These warning signs might include high blood pressure and high cholesterol.
When left unchecked and unmedicated, these conditions may lead to heart and blood vessel damage. However, a trusted health care provider may be able to recommend lifestyle adjustments and medications that could help you manage such issues.
No. 3: Secure health insurance
Having ample health insurance puts you in a better position to care for your heart health. Yet, according to the American Heart Association, about 7.3 million Americans with cardiovascular disease don’t have health insurance. This lack of coverage makes the uninsured less likely to receive necessary medical care, often leading to worse medical outcomes and higher death rates.
Robin Townsend, a ValuePenguin technical writer whose focus is health and life insurance, notes that under the Affordable Care Act (ACA), ACA-compliant health plans (issued after March 23, 2010) won’t deny you coverage or charge you more based on preexisting health conditions or increased risk factors.
"This is true for individual and group health insurance," Townsend says. "Once a person is enrolled, the plan can’t deny coverage or raise rates based solely on health."
No. 4: Consider life insurance
Having adequate life insurance coverage in place can offer financial protection for your loved ones if something happens to you. Yet Townsend notes that because life insurance companies can consider health, an insurer can deny you coverage or charge you more if you’re an at-risk consumer.
On a positive note, life insurance companies offer multiple types of coverage, even for people with preexisting medical conditions. Just because you can’t qualify for one policy doesn’t mean there aren’t life insurance options available to you.
"Some life companies might reduce rates for existing customers who show they’re making lifestyle changes and lowering their heart health risks," Townsend says.
How COVID-19 affects the heart
Although much is still unknown about the long-term health effects of COVID-19, there is evidence that the disease can lead to heart issues and damage — sometimes to a severe degree. Cardiologist Wendy Susan Post of Johns Hopkins Medicine notes on the system’s website that possible heart-related complications after COVID-19 may include:
- Chest pain
- Heart muscle damage
- Decreased heart function
- Blood vessel inflammation
- Blood clots
- Irregular heart rhythms
The pandemic makes maintaining a heart-healthy lifestyle more important than ever. According to the CDC, the presence of heart conditions like coronary artery disease and high blood pressure could make you more susceptible to serious illness if you contract COVID-19.
Some people harbor concerns about potential heart-related side effects from COVID-19 vaccines. However, a recent Oxford University-led study of about 38 million vaccinated individuals revealed noteworthy results. The study found that COVID-19 infections have a higher chance of leading to rare cardiovascular complications (e.g., heart inflammation, irregular heartbeat, myocarditis, etc.) compared with similar complications caused by vaccines.
While this report analyzed pre-pandemic data because of availability, time will tell how future heart-health statistics take shape in the U.S. when COVID-19 enters into consideration.
Methodology
ValuePenguin analysts used the latest available data from the Centers for Disease Control and Prevention and the American Heart Association to determine the prevalence of various heart conditions and health behaviors in the 50 states and the District of Columbia. Analysts further used population data from the U.S. Census Bureau to weight some of these results to account for states with older populations.