Worst U.S. Cities for Heart Health

In Rocky III we see two knockouts in the ring—and one in the locker room, where Mickey is KO'd by a heart attack. It's a familiar script: Philly guy goes up against heavyweight heart disease and is leveled.
Here's the tale of the tape. We began with death rates for heart disease and then factored in big clues to cardiac woes: the number of people who smoke, don't exercise, or are overweight or obese, along with the number who have type 2 diabetes, high blood pressure, or high cholesterol (all data from the CDC). Next we checked how many households floss (inflammation from gum disease can contribute to heart risks) and take cholesterol-lowering meds (SimplyMap). Finally, we included EPA stats on the number of bad-air days.
Here are the 10 cities that fell at the bottom of our rankings.

This tornado-prone town has a high smoking rate and a high use of cholesterol medication. Trying to quit? Distract yourself with exercise. People who work out when they feel cigarette cravings are more likely to kick the habit, according to a British study published last month.We pity Cleveland's singles: The town has the lowest flossing rate of any major U.S. city. The heart connection? Scientists believe that the inflammatory effects of gum disease can also cause inflammation in your arteries.If you do have a heart attack, hope you're not in Buffalo at the time.
 

This city has one of the top heart attack death rates in the country. To increase your survival chances, get help at the first sign of trouble. A recent study found that people who had a heart attack at the gym were more likely to survive, likely because bystanders ensured emergency assistance arrived quickly.





Toledo residents suffer from the triple whammy of smoking, high cholesterol, and excess weight—all risk factors for heart disease.










The Marlboro Man would feel at home in St. Louis, which has the highest smoking rates in the nation. Smoking constricts blood vessels, contributing to high blood pressure.











This Midwestern town has one of the top high cholesterol scores, but one of the lowest rates of cholesterol medication use.










This port town is home to portly residents: Baltimore has the highest rate of overweight people in the United States. (Overweight is a different classification from obese.) Weight is one of the biggest contributors to high blood pressure.






The capital of West Virginia is the city with the highest rate of high blood pressure in the country, according to CDC data. While the first advice you hear to beat high blood pressure is usually "eat less salt," exercise also plays a large role. A recent study in Hypertension found that men with moderate levels of fitness experienced the same protection from high blood pressure as very fit men. The takeaway? You don't have to be a marathoner to keep your heart healthy—just move for 30 minutes a day, five times per week.

Birmingham landed near the top of our list for unhealthy air days and hypertension rates. Exposure to ozone-polluted air increases markers of inflammation in the blood and changes your heart's rhythm, a 2012 Circulation study reports.






The city of brotherly love has one of the top high blood pressure rates combined with one of the most sedentary populations. And that's a problem, people with a family history of high blood pressure who are fit have a 34 percent lower risk of developing the condition compared to unfit people, a 2012 study in Hypertension found.