The US is facing a heart health crisis of unimaginable proportions.
And yet, some Americans are faring better than others, including certain states.
I’ll be the first to say that categorizing ‘healthier’ states won’t solve our state of emergency.
But it can give us a clue about what went wrong — and what we need to turn things around.
Breaking down the data
Before we dive into the specifics, I want to give you an overview of the data.
To celebrate National Heart Month, Forbes Health collected data on 16 different factors related to heart health and heart disease. This allowed them to rank statewide health based on two core factors: lifestyle and the prevalence of heart conditions.
With this logic, the 10 heart-healthiest states in the US are:
- Colorado
- Massachusetts
- New Hampshire
- Utah
- Connecticut
- Washington
- New Jersey
- Minnesota
- Hawaii
- Rhode Island
Interestingly, 70% of these are located in Northern areas.
Now let’s look at the 10 least heart-healthy states, which include:
- Arkansas
- Mississippi
- Tennessee
- Louisiana
- West Virginia
- Alabama
- Ohio
- Oklahoma
- Kentucky
- Indiana
The vast majority of these are located in the southern half of the US, with just two (Indiana and Ohio) falling into the northern half.
So what does the data tell us?
I have a few thoughts.
Why are some states heart-healthier than others?
There’s no single reason why some states appear to have healthier hearts than others.
Remember: causation is not the same thing as correlation.
That said, I see a few primary reasons why we see such a divide between each state — particularly the cultural norms between Northern and Southern cooking.
Consumption of whole, real food
Let’s start with the eating habits of the North versus the South.
Cheeses, apples, and walleye are common staples in colder climates.
Comfort foods like grits, biscuits, and tater tots are more common down south.
It’s true that sweet tea, fried chicken, and pecan pie aren’t only available in Southern states, but they’re far more likely to be dietary staples below the Mason–Dixon line.
One study determined that the Southern-style diet — which includes the eating habits of North Carolina, South Carolina, Georgia, Tennessee, Alabama, Mississippi, Arkansas, and Louisiana — can lead to a 46% higher risk of heart disease and sudden cardiac death.
I’m not demonizing the Southern diet. Some Southern staples are incredibly healthy, including eggs and organ meats.
But the research shows that the further South you live, the more likely you’ll eat processed foods. And with 73% of the US food supply now classified as ultra processed, it’s harder than ever to keep near-food objects out of our pantries.
Exercise norms
The data also has some interesting insights on exercise rates per state.
The least heart-healthy state, Arkansas, saw just 70% of respondents exercising once per month. This is almost 15% less than the healthiest state of Colorado (which saw 83.5% of those surveyed exercising).
But these numbers reflect a greater issue — Americans simply aren’t exercising enough. Only 28% of us exercise more than 150 minutes per week. For those living in rural areas, this number falls to 16%.
In the South, which makes up nearly half of all Americans living in rural areas, only 22% of people meet the weekly exercise benchmarks.
Interestingly, people located in western America (which, by the way, has become the most urbanized part of the US) are 6.5% more likely to meet exercise guidelines.
Less healthy habits
Drinking and smoking are some of the worst habits affecting our heart health.
Unfortunately, they’re both more common in the Southern US.
Let’s compare the least heart-healthy state to the most heart-healthy state:
| Colorado | Arkansas | |
|---|---|---|
| Heavy drinkers | 8.3 % | 8.5 % |
| Smokers | 10.8 % | 19.2 % |
The percent increase of heavy drinkers may not be much different, but the percent of active smokers is nearly double in Arkansas.
Regardless of what the media may tell you, alcohol and tobacco are not harmless substances.
I encourage you to quit so you can regain and maintain your metabolic health.
Nightly sleep
I’m a big believer that better sleep leads to healthier, longer-lasting hearts.
This isn’t just my opinion, though — the data reflects this as well.
In the study, 29% of Colorado respondents reported less than seven hours of sleep per night.
In Arkansas, that number was 38%.
This doesn’t mean getting more sleep instantly leads to a healthier heart. But with one in three Americans getting less than the recommended amount, it’s clear the lack of shuteye is increasing our risks for heart disease.
Education availability
There are hundreds of studies correlating higher education to better intergenerational health. Heart health is no different, especially when it comes to the intricacies of nutrition.
But lack of education doesn’t just boil down to degrees and diplomas. Cutting-edge research and doctors who ‘get’ it may be much harder to find in rural (aka southern) areas.
We can translate this to a larger context.
How many doctors weren’t educated on metabolic health while in school?
How many of us grew up thinking low-fat diets were healthy, or that cereal and fruit juice were the foundation of a healthy breakfast?
The spread of research on social media (and online conversations with health experts) are helping to level the playing field in traditionally underserved areas.
So where do we go from here?
Although some states may be ‘healthier’ than others, America’s downward spiral isn’t contained to just a few areas.
At the end of the day, only 7% of US adults are cardiometabolically healthy. There may be a concentration of metabolically-sound adults in some states, but the reality is it doesn’t matter where you live — you’re not automatically protected against heart disease.
Whether you live in Colorado or Arkansas, I urge you to look for ways to improve your metabolic health. This could be getting more sleep per night, eating whole, real food, or finding a new doctor so you can get a professional by your side.
Looking to fire your doctor and hire a new one? I’ve got a vetting guide available to help.