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.

10. Reading, Penn.
> Pct who have had heart attack: 6.0%
> Pct. obese: 32.8% (9th highest)
> Pct. who smoke: 21.6% (73rd highest)
> Median household income: $52,307

As many as 6% of people surveyed in the Reading area had a heart attack, among the highest rates in the country. Nearly 33% of them were obese, higher than all but eight other metro areas and eight percentage points higher than the national obesity rate. Lack of exercise is likely contributing to the problem. Just 46.4% of residents said they had exercised at least three times for at least 30 minutes in the previous week. This was among the lowest percentages in the country and well below the nearly 53% of people across the country who worked out at least that much.

9. Duluth, Minn.-Wisc.
> Pct. reporting heart attack: 6.2% (tied for 8th highest)
> Pct. obese: 26.9% (68th highest)
> Pct. who smoke: 19.6% (78th lowest)
> Median household income: $46,110

In many respects, people in Duluth were in better health than the country as a whole. For instance, the percentage of people with both high blood pressure and high cholesterol were below the national rate. However, nearly 27% of people surveyed were considered obese, higher than the 24.8% obesity rate across the country. Like most areas on this list, Duluth’s median household income was lower than the national median. In 2011, it was about $4,400 less than the U.S. median of $50,502. In addition, Duluth had a slightly higher poverty rate of 16.6% than the U.S. poverty rate of 15.9%.

Also Read: Ten Cities Where the Poor Can’t Get Rich

8. Cape Coral-Fort Myers, Fla.
> Pct. reporting heart attack: 6.2% (tied for 8th highest)
> Pct. obese: 23.1% (48th lowest)
> Pct. who smoke: 19.9% (82nd lowest)
> Median household income: $45,266

Overall physical health in Cape Coral was better than the country as a whole. However, 32% of adults had been told they had high blood pressure, above the 27.6% across the country. Moreover, 30% of those surveyed had been told they had high cholesterol, also much higher than the 24.% nationwide. Still, those in Cape Coral tended to display healthier behaviors than the nation as a whole. For instance, 74.4% of people said they ate healthy all through the previous day, higher than all but four other metro areas. Also, 54.7% of people said they exercised at least 30 minutes in three or more days the previous week, also above the national rate.

7. Olympia, Wash.
> Pct. reporting heart attack: 6.3% (tied for 5th highest)
> Pct. obese: 23.8% (58th lowest)
> Pct. who smoke: 21.5% (78th highest)
> Median household income: $60,061

Olympia ranked as one of the worst metropolitan areas for physical health, according to the Gallup-Healthways study. People in the area had higher rates of recurring pain than the country as a whole, especially in the neck and back. The percentage of people who smoked, 21.5%, was also higher than the 19.1% smoking rate nationwide. Similarly, the percentage of people who regularly exercised was also below the national rate. Unlike most of the metro areas on this list, Olympia residents were more educated and earned a higher income than the average of U.S. residents. More than 94% of adult residents had at least a high school diploma as of 2011, compared to just under 86% nationally.

6. Knoxville, Tenn.
> Pct. reporting heart attack: 6.3% (tied for 5th highest)
> Pct. obese: 24.2% (66th lowest)
> Pct. who smoke: 19.2% (74th lowest)
> Median household income: $44,514

Physical health in Knoxville is worse than most of the country. Nearly 14% of adults in the area were diagnosed with diabetes, compared to 10.2% of people across the United States. In addition, more than 34% of adults were told they had high blood pressure, while just under 30% were told they had high cholesterol, both considerably higher than the national rates. Just 47.7% of people in Knoxville said they worked out at least three days in the past week for at least 30 minutes a session, compared to 52.9% nationwide. The percentage of people who said it was easy to get affordable fruits and vegetables was lower than the country as a whole, as was the percentage who said they had enough money for both food and medicine.

5. Charleston, W.Va.
> Pct. reporting heart attack: 6.3% (tied for 5th highest)
> Pct. obese: 32.9% (8th highest)
> Pct. who smoke: 32.1% (the highest)
> Median household income: $40,990

Physical health in Charleston was worse than any other metro area except for nearby Huntington-Ashland. More than 41% of the people in the Charleston area had been told they had high blood pressure, the second-highest rate in the country. Also, nearly 33% of the people in the Charleston metro were obese, higher than all but seven other areas. Like many other places on this list, people in Charleston as a whole tended to have poor health habits. More than 32% of people smoked, the highest percentage in the country. In addition, the percentages of people who exercised and ate healthy regularly were below the national rates.

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4. Utica-Rome, N.Y.
> Pct. reporting heart attack: 6.6%
> Pct. obese: 30.1% (29th highest)
> Pct. who smoke: 26.7% (16th highest)
> Median household income: $45,111

Like most other cities on this list, Utica had poor physical health and healthy behavior. More than 34% of people have been told they had high blood pressure, considerably higher than the 27.6% of people across the U.S. who have been told the same thing. Just over 47% of people in the area said they exercised at least three days in the previous week for at least 30 minutes. This was among the bottom 10 of all metro areas. In addition, the area ranked seventh worst in the Gallup Healthways survey for overall life evaluation, a measure that looks at whether people are thriving, struggling or suffering in their day-to-day life.

3. Fort Smith, Ark.-Okla.
> Pct. reporting heart attack: 6.7% (tied for 2nd highest)
> Pct. obese: 28.9% (42nd highest)
> Pct. who smoke: 25.8% (21st highest)
> Median household income: $35,965

Physical health in the Fort Smith area was worse than all but the Charleston and the Huntington, W.Va., areas, according to Gallup. Just over 60% of the people surveyed said they slept well in the previous evening, the lowest of all metro areas. Meanwhile, more than 42% of the population noted that they had recurring neck or back pain, higher than all other areas. In addition to having higher than average smoking rates and lower than average rates of consistent exercise, just over 49% of people in Fort Smith said they ate five servings of fruits and veggies in at least four days in the previous week, lower than all but three other metro areas. The 2011 median household income in the Fort Smith area was just $35,965, among the lowest in the country.

2. Davenport-Moline-Rock Island, Iowa-Ill.
> Pct. reporting heart attack: 6.7% (tied for 2nd highest)
> Pct. obese: 26.3% (82nd highest)
> Pct. who smoke: 21.0% (91st highest)
> Median household income: $47,122

The Davenport metro area actually performed well in terms of overall physical health, scoring near the top 20% of all metro areas. However, the quad cities area did have its weaknesses. As many as 28.7% were told they had high blood pressure, far from the highest but more than a percentage point higher than the national rate. The Davenport area also had a higher percentage of people experiencing recurring pain, especially in the knee or leg area. While people in the metro area also ate healthier and exercised more frequently than the nation as a whole, 21% of adults in the area smoked, compared to 19.2% across the country.

1. Huntington-Ashland, W.Va.-Ky.-Ohio
> Pct. reporting heart attack: 8.9%
> Pct. obese: 37.7% (2nd highest)
> Pct. who smoke: 30.0% (3rd highest)
> Median household income: $36,894

A whopping 8.9% of people in the Huntington-Ashland area said they had a heart attack, higher than any other metro area. Overall, people in the area had the worst physical health than any other metro area measured by Gallup and Healthways. More than 43% said they had high blood pressure, while 39.6% said they had recurring pain in either the knee or leg, both higher than any other area surveyed. Nearly 38% of the area’s population was considered obese, higher than all but one other area. Poor health habits were a problem in the Huntington area. As many as 30% of the population smoked, higher than all but two other areas. Meanwhile, 46.5% of people said they worked out at least three days in the previous week for at least 30 minutes, also among the lowest in the country.

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