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Since the COVID-19 pandemic began last year, much attention has been paid to the ways the risk levels for severe illness or death from the virus interacts with other health conditions. Age is one of the most significant risk factors, but COVID-19 is also particularly damaging for individuals who are obese or have preexisting heart conditions. For that reason, one important indicator of an individual’s COVID-19 risk is their cholesterol levels.
Cholesterol is a fatty substance found in the blood that helps produce cell membranes and hormones in the body. The body produces cholesterol naturally through the liver, but diet—especially the type and amount of fatty foods an individual eats—is a major contributor to cholesterol levels in the body. Cholesterol also increases with age as the body becomes less capable of clearing it from the blood. Because of this, a key component to healthy aging is adopting strategies and behaviors to maintain healthy blood cholesterol levels. While cholesterol has an important role to play in the functioning of the body, having too much of it can invite a host of other health problems.
As cholesterol levels increase, it can lead to the buildup of plaque in blood vessels and restrict the flow of blood in the body. This can have a major impact on cardiac health, and many severe health conditions are positively correlated with high cholesterol levels. Coronary heart disease—when the arteries that supply blood to the heart become obstructed by plaque buildup, a process that occurs more commonly when cholesterol is high—can cause chest pain and heart attacks. Restricted blood flow can also lead to strokes, which occur when the brain’s supply of blood is interrupted. And as the heart works harder to pump blood through the body with clogged blood vessels, high blood pressure follows.
While high cholesterol can be caused by genetic factors, it often results from poor diet, a lack of physical activity, and other unhealthy behaviors. Both obesity and diabetes—which are similarly made worse by unhealthy eating—shows up more commonly in places where cholesterol levels are high. On top of diet, smoking can also exacerbate cholesterol problems by increasing the stickiness of cholesterol in the blood and making it more likely to accumulate in the bloodstream. For that reason, smoking and cholesterol levels also show a positive correlation.
High cholesterol is a common problem throughout the U.S., but locations in the Southern U.S. show the greatest concentrations of residents reporting high cholesterol levels. There are several reasons why this might be the case. For one, the diet of the region has more added fats, fried foods, meats, and other foods that contribute to high cholesterol levels. Further, many parts of the Southern U.S. are rural or low-income communities where healthy food options are harder to find or more expensive than fatty, processed options. Finally, many other correlated risk factors like obesity and smoking are also more common in the South.
To find the states and cities with the highest cholesterol levels, researchers at Sidecar Health used data from the Centers for Disease Control and Prevention. Locations were ranked based on the proportion of adults who were ever told by a healthcare professional that they had high cholesterol. In the event of a tie, the location with the higher prevalence of coronary heart disease (one of the most common adverse health conditions resulting from high cholesterol) was ranked higher.
Here are the U.S. cities suffering the most from high cholesterol.
Large Cities With High Cholesterol Levels
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15. Nashville-Davidson, TN
- Percentage of adults who ever had high cholesterol: 30.7%
- Percentage of adults who ever had coronary heart disease: 6.5%
- Percentage of adults who ever had a stroke: 3.4%
- Percentage of adults who ever had high blood pressure: 35.6%
- Percentage of adults who are obsese: 32.1%
- Percentage of adults who ever had diabetes: 11.2%
- Percentage of adults who smoke: 20.9%
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14. New Orleans, LA
- Percentage of adults who ever had high cholesterol: 30.9%
- Percentage of adults who ever had coronary heart disease: 6.9%
- Percentage of adults who ever had a stroke: 4.5%
- Percentage of adults who ever had high blood pressure: 40.0%
- Percentage of adults who are obsese: 33.7%
- Percentage of adults who ever had diabetes: 13.9%
- Percentage of adults who smoke: 19.8%
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13. Wichita, KS
- Percentage of adults who ever had high cholesterol: 31.0%
- Percentage of adults who ever had coronary heart disease: 6.7%
- Percentage of adults who ever had a stroke: 3.3%
- Percentage of adults who ever had high blood pressure: 33.5%
- Percentage of adults who are obsese: 36.5%
- Percentage of adults who ever had diabetes: 12.4%
- Percentage of adults who smoke: 20.1%
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12. Tampa, FL
- Percentage of adults who ever had high cholesterol: 31.0%
- Percentage of adults who ever had coronary heart disease: 6.8%
- Percentage of adults who ever had a stroke: 3.7%
- Percentage of adults who ever had high blood pressure: 34.2%
- Percentage of adults who are obsese: 34.0%
- Percentage of adults who ever had diabetes: 12.9%
- Percentage of adults who smoke: 19.0%
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11. Louisville/Jefferson County, KY
- Percentage of adults who ever had high cholesterol: 31.2%
- Percentage of adults who ever had coronary heart disease: 6.9%
- Percentage of adults who ever had a stroke: 3.0%
- Percentage of adults who ever had high blood pressure: 38.0%
- Percentage of adults who are obsese: 31.3%
- Percentage of adults who ever had diabetes: 10.7%
- Percentage of adults who smoke: 23.2%
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10. Memphis, TN
- Percentage of adults who ever had high cholesterol: 31.2%
- Percentage of adults who ever had coronary heart disease: 7.7%
- Percentage of adults who ever had a stroke: 5.0%
- Percentage of adults who ever had high blood pressure: 40.6%
- Percentage of adults who are obsese: 37.0%
- Percentage of adults who ever had diabetes: 16.1%
- Percentage of adults who smoke: 24.3%
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9. Anaheim, CA
- Percentage of adults who ever had high cholesterol: 31.3%
- Percentage of adults who ever had coronary heart disease: 5.6%
- Percentage of adults who ever had a stroke: 2.9%
- Percentage of adults who ever had high blood pressure: 28.4%
- Percentage of adults who are obsese: 24.4%
- Percentage of adults who ever had diabetes: 10.6%
- Percentage of adults who smoke: 12.4%
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8. Charlotte, NC
- Percentage of adults who ever had high cholesterol: 31.5%
- Percentage of adults who ever had coronary heart disease: 5.9%
- Percentage of adults who ever had a stroke: 3.3%
- Percentage of adults who ever had high blood pressure: 33.0%
- Percentage of adults who are obsese: 30.4%
- Percentage of adults who ever had diabetes: 10.3%
- Percentage of adults who smoke: 15.7%
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7. Dallas, TX
- Percentage of adults who ever had high cholesterol: 32.1%
- Percentage of adults who ever had coronary heart disease: 7.0%
- Percentage of adults who ever had a stroke: 3.9%
- Percentage of adults who ever had high blood pressure: 35.6%
- Percentage of adults who are obsese: 37.3%
- Percentage of adults who ever had diabetes: 12.7%
- Percentage of adults who smoke: 17.0%
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6. Tulsa, OK
- Percentage of adults who ever had high cholesterol: 32.2%
- Percentage of adults who ever had coronary heart disease: 7.4%
- Percentage of adults who ever had a stroke: 3.7%
- Percentage of adults who ever had high blood pressure: 35.8%
- Percentage of adults who are obsese: 33.9%
- Percentage of adults who ever had diabetes: 12.2%
- Percentage of adults who smoke: 20.6%
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5. Detroit, MI
- Percentage of adults who ever had high cholesterol: 32.3%
- Percentage of adults who ever had coronary heart disease: 8.8%
- Percentage of adults who ever had a stroke: 6.1%
- Percentage of adults who ever had high blood pressure: 46.7%
- Percentage of adults who are obsese: 44.1%
- Percentage of adults who ever had diabetes: 18.2%
- Percentage of adults who smoke: 29.3%
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4. Arlington, TX
- Percentage of adults who ever had high cholesterol: 32.4%
- Percentage of adults who ever had coronary heart disease: 6.5%
- Percentage of adults who ever had a stroke: 3.2%
- Percentage of adults who ever had high blood pressure: 34.6%
- Percentage of adults who are obsese: 33.5%
- Percentage of adults who ever had diabetes: 12.1%
- Percentage of adults who smoke: 16.2%
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3. Oklahoma City, OK
- Percentage of adults who ever had high cholesterol: 32.5%
- Percentage of adults who ever had coronary heart disease: 7.4%
- Percentage of adults who ever had a stroke: 3.6%
- Percentage of adults who ever had high blood pressure: 36.3%
- Percentage of adults who are obsese: 36.5%
- Percentage of adults who ever had diabetes: 11.9%
- Percentage of adults who smoke: 19.5%
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2. Fort Worth, TX
- Percentage of adults who ever had high cholesterol: 32.8%
- Percentage of adults who ever had coronary heart disease: 7.1%
- Percentage of adults who ever had a stroke: 3.7%
- Percentage of adults who ever had high blood pressure: 35.7%
- Percentage of adults who are obsese: 35.2%
- Percentage of adults who ever had diabetes: 13.5%
- Percentage of adults who smoke: 17.0%
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1. Houston, TX
- Percentage of adults who ever had high cholesterol: 33.2%
- Percentage of adults who ever had coronary heart disease: 7.1%
- Percentage of adults who ever had a stroke: 3.8%
- Percentage of adults who ever had high blood pressure: 33.4%
- Percentage of adults who are obsese: 37.7%
- Percentage of adults who ever had diabetes: 14.9%
- Percentage of adults who smoke: 16.7%
Methodology & Detailed Findings
The data used in this analysis is from the CDC’s Places and Behavioral Risk Factor Surveillance System (BRFSS) datasets. To identify the locations with the most residents with high cholesterol, researchers ranked locations based on the proportion of adults who were ever told by a healthcare professional that they had high cholesterol (among adults who had their cholesterol checked within the past five years). In the event of a tie, the location with the higher prevalence of coronary heart disease (one of the most common adverse health conditions resulting from high cholesterol) was ranked higher.
The statistics reported are the latest available for each geography type. The city-level data is from the Places 2020 data release, which reflects statistics from 2018. The state- and national-level data is from the BRFSS 2020 data release, which reflects statistics from 2019.
To improve relevance, only cities with at least 100,000 residents were included in the analysis. Additionally, cities were grouped into cohorts based on population size: small (100,000–149,999), midsize (150,000–349,999), and large (350,000 or more).
