Heart Disease in America: The States with the Highest Mortality Rates
Key highlights
- Oklahoma has the highest heart disease death rate in the US — 250.7 per 100,000, nearly 51% above the national average.
- More than 1 in 4 deaths (27%) in Oklahoma are caused by heart disease, the highest share nationwide.
- The South dominates the rankings, accounting for 7 of the 10 worst-affected states.
- New Mexico has seen the biggest increase in heart disease deaths, rising by 13.7% since 2014.
- Heart disease remains America’s leading killer, responsible for 680,981 deaths in 2023.
Heart disease continues to be the leading cause of death in the United States, responsible for nearly 700,000 deaths in a single year. Nearly half of all U.S. adults, equivalent to 130.6 million people, are living with some form of cardiovascular disease, highlighting the true scale of the issue nationwide.
But new data reveal that the burden of heart disease is not spread evenly across the country. In Oklahoma, the deadliest state for heart disease, there are 250.7 deaths per 100,000 people, 50.8% higher than the national average. Several other Southern states also record disproportionately high death rates, showing major geographic differences in heart health outcomes.
To uncover where Americans are most affected, this study analyses heart disease death rates across every state, revealing where rates are highest, where they have risen fastest, and how each state compares to the national picture.
Obesity is one of the biggest risk factors for heart disease
Regardless of its cause, obesity is one of the leading contributors to heart disease risk. And, with more than two in five Americans being classed as obese, it remains a major public health concern.
Excess weight can increase the risk of high blood pressure, high cholesterol and type 2 diabetes, all of which place added strain on the heart. But losing weight is not always straightforward, and many people find it difficult to reach or maintain a healthy BMI.
Alongside lifestyle changes such as diet and exercise, medical weight loss treatments like compounded semaglutide and tirzepatide are increasingly being used to support weight loss as part of wider efforts to improve heart health.
Oklahoma has the highest heart disease death rate in the United States
Heart disease death rates vary sharply across the United States, but Southern states dominate the rankings. Seven of the 10 worst-affected states are in the South, with Oklahoma recording the highest death rate nationwide at 250.7 deaths per 100,000 people.
The national average stands at 166.3 deaths per 100,000 people, meaning Oklahoma’s rate is more than 50% higher than average.
| Rank | State | Total Heart Disease Deaths | Heart Disease Deaths per 100,000 People |
|---|---|---|---|
| 1 | Oklahoma | 11,913 | 250.7 |
| 2 | Mississippi | 8,441 | 235.6 |
| 3 | Alabama | 14,587 | 227.3 |
| 4 | Arkansas | 8,443 | 218.8 |
| 5 | Louisiana | 11,895 | 217.7 |
| 6 | Tennessee | 17,955 | 210.2 |
| 7 | West Virginia | 5,244 | 204.8 |
| 8 | Michigan | 26,205 | 199.5 |
| 9 | Kentucky | 10,988 | 197.1 |
| 10 | Missouri | 15,137 | 188.6 |
1. Oklahoma has the highest heart disease death rate in the U.S.
Oklahoma records 250.7 heart disease deaths per 100,000 people, the highest rate in the country and 50.8% above the national average.
Diet may be one reason why the state ranks so poorly. Just 3.8% of adults in Oklahoma eat the recommended five daily portions of fruit and vegetables, the lowest share in the country. Eating five portions a day has been linked to a 20% lower risk of coronary heart disease, meaning most residents are missing out on a key protective factor.
2. Mississippi has the second-highest heart disease death rate
Mississippi records 235.6 heart disease deaths per 100,000 people, making it the second worst-affected state in the country.
The state also has one of the highest obesity rates nationwide, with 40.4% of adults classified as obese. Excess weight increases the risk of conditions such as high blood pressure, diabetes and high cholesterol, all of which can contribute to heart disease.
3. Alabama ranks third for heart disease deaths per capita
Alabama records 227.3 heart disease deaths per 100,000 people, 36.7% above the national average.
Several lifestyle factors may be contributing to the state’s high rate. Around 38.9% of adults are obese, only 4.8% eat the recommended amount of fruit and vegetables each day, and 14% smoke, all of which are linked to poorer heart health.
Heart disease death rates are rising fastest in New Mexico
Despite heart disease death rates falling slightly across the United States overall, not every state is seeing progress. Nationally, deaths per 100,000 people decreased by just 0.2% between 2014 and 2023, but several states have experienced sharp increases over the same period.
| Heart Disease Deaths per 100,000 People | ||||
|---|---|---|---|---|
| Rank | State | 2014 | 2023 | Percentage Change |
| 1 | New Mexico | 143.3 | 163.0 | 13.7% |
| 2 | Iowa | 157.3 | 176.3 | 12.1% |
| 3 | Nebraska | 143.0 | 158.8 | 11.0% |
| 4 | Oklahoma | 228.1 | 250.7 | 9.9% |
| 5 | Montana | 147.8 | 162.2 | 9.7% |
| 6 | Maine | 147.9 | 161.6 | 9.3% |
| 7 | Wisconsin | 155.1 | 167.3 | 7.9% |
| 8 | Oregon | 132.1 | 142.3 | 7.7% |
| 9 | Utah | 151.0 | 162.4 | 7.5% |
| 10 | Kansas | 157.4 | 168.9 | 7.3% |
1. New Mexico has seen a 13.7% increase in heart disease deaths
Despite ranking 21st overall for heart disease deaths per 100,000 people, New Mexico stands out for how quickly its death rate has risen.
Between 2014 and 2023, the state’s heart disease death rate rose from 143.3 per 100,000 people in 2014 to 163.0 in 2023, an increase of 13.7%.
Although New Mexico’s overall death rate remains slightly below the national average, the pace of increase is notable. In fact, its rise is 1.6 percentage points higher than Iowa, the state with the second-fastest increase.
Stress may be one contributing factor. According to 2026 research, New Mexico ranks among the most stressed states in the country, and chronic stress can increase the risk of high blood pressure, poor sleep, smoking, and alcohol consumption, all of which are linked to poorer heart health.
2. Iowa has seen the second-fastest increase in heart disease deaths
Iowa has recorded a 12.1% rise in heart disease deaths per 100,000 people since 2014, increasing from 157.3 to 176.3.
A decade ago, Iowa’s heart disease death rate was below the national average. Today, it is above it.
One possible factor is alcohol consumption. Around 21% of adults in Iowa drink excessively, one of the highest shares in the country. Excessive alcohol use can increase the risk of high blood pressure, obesity, and other conditions linked to heart disease.
3. Nebraska records the third-highest increase in heart disease deaths
Nebraska has seen heart disease deaths rise by 11.0%, making it one of only three states where the increase exceeds 10% across the period studied.
The state’s death rate rose from 143.0 per 100,000 people in 2014 to 158.8 in 2023. While that remains below the national average, the direction of travel is concerning.
Several lifestyle factors may be contributing to the increase. Nebraska has one of the highest obesity rates in the country at 37.6%, while 20.5% of adults drink excessively and just 6.9% eat the recommended amount of fruit and vegetables each day.
Nebraska has one of the highest obesity rates of any state, 37.6%, and more than one in five (20.4%) people drink excessively – both of which are major contributing factors.
The states where heart disease accounts for the highest share of all deaths
Heart disease does not just vary by death rate. In some states, it also makes up a much larger share of all deaths than in others.
Nationally, heart disease is responsible for 21.7% of all deaths. But in several states, it accounts for closer to one in four, showing how dominant it has become as a cause of mortality.
| Rank | State | Total Deaths | Heart Disease Deaths | Heart Disease Deaths (%) |
|---|---|---|---|---|
| 1 | Oklahoma | 44,172 | 11,913 | 27.0% |
| 2 | New York | 162,173 | 41,172 | 25.4% |
| 2 | Michigan | 103,302 | 26,205 | 25.4% |
| 4 | Alabama | 59,237 | 14,587 | 24.6% |
| 5 | Nevada | 29,008 | 6,989 | 24.1% |
| 5 | Mississippi | 35,051 | 8,441 | 24.1% |
| 5 | Louisiana | 49,437 | 11,895 | 24.1% |
| 8 | Arkansas | 35,758 | 8,443 | 23.6% |
| 9 | New Jersey | 75,367 | 17,748 | 23.5% |
| 9 | Iowa | 32,552 | 7,644 | 23.5% |
1. In Oklahoma, heart disease accounts for 27% of all deaths
Heart disease accounts for 27.0% of all deaths in Oklahoma, the highest share of any state and 5.3 percentage points above the national average.
Diet may be one reason why the state ranks so poorly. Oklahoma has the lowest share of adults eating the recommended amount of fruit and vegetables, with just 3.8% meeting the target. More than one in five residents also report eating fewer than one portion of vegetables per day.
2. In New York, heart disease accounts for 25.4% of all deaths
In New York, heart disease is responsible for 25.4% of all deaths, the joint second-highest share in the country.
Unlike many of the other states in the ranking, New York has relatively lower levels of obesity, smoking and excessive alcohol consumption. One reason heart disease may account for a greater share of deaths is that the state has one of the lowest cancer death rates in the country, meaning fewer deaths are attributed to other major illnesses.
3. In Michigan, heart disease accounts for 25.4% of all deaths
Michigan also records 25.4% of all deaths from heart disease, matching New York for the second-highest share nationwide.
The state already has one of the highest heart disease death rates in the country, with 199.5 deaths per 100,000 people. On top of this, 36.2% of adults in Michigan are classified as obese and 16.8% report drinking excessively, both of which are linked to a higher risk of heart disease.
What the experts say…
“Heart disease continues to place a major burden on the United States, but this data shows that the impact is not evenly spread. States with high obesity rates consistently rank among the worst affected, reinforcing the close link between excess weight and cardiovascular disease,” says Rob Stransky, President at NiceRx.
More than 172 million U.S. adults are living overweight or with obesity, and carrying excess weight can increase the risk of high blood pressure, high cholesterol and type 2 diabetes, all of which place added strain on the heart. Over time, this can significantly raise the risk of serious complications such as heart attacks and strokes.
Losing weight is not always straightforward, particularly for people who have struggled for years to manage their weight through diet and exercise alone. Sustainable lifestyle changes remain the foundation, including eating a balanced diet, staying active, reducing processed foods and improving sleep. But for some people, medically guided weight-loss support can also play an important role.
Treatments such as compounded semaglutide and tirzepatide are increasingly being explored as part of a broader weight management strategy. When used alongside healthier lifestyle habits and under appropriate clinical guidance, these treatments may help some people lose weight more effectively and reduce their long-term risk of heart disease.”
Methodology
NiceRx is a US-based healthcare company that helps patients access prescription treatments and clinically guided support through a fully online service.
Because obesity is one of the leading risk factors for heart disease, understanding where heart disease is most prevalent can help highlight where better weight management support may be needed. This research explores how heart disease death rates vary across the United States, where they are increasing most quickly, and where heart disease accounts for the highest share of overall deaths.
To explore these trends, we collected and analyzed data using the following sources:
We ranked each U.S. state on the following factors, with all data sourced from https://www.cdc.gov/nchs/state-stats/deaths/heart-disease.html
1. Heart Disease Death Rate by State – Based on age-adjusted heart disease death rates per 100,000 residents in 2023.
2. Change in Heart Disease Deaths – Based on the percentage change in heart disease death rates per 100,000 residents between 2014 and 2023. This period includes pandemic years, which may have influenced mortality trends.
3. Share of Heart Disease Deaths – Based on the percentage of all recorded deaths in 2023 attributed to heart disease. Total deaths data were sourced from https://wonder.cdc.gov/controller/datarequest/D158. This metric reflects the share of deaths and does not measure overall disease prevalence or risk.
