By TOM BREEN, Associated Press Writer Fri Dec 29, 8:18 PM ET

CHARLESTON, W.Va. - West Virginia is making slight yet discernible progress in reducing deaths from heart disease, but it remains one of the states hit hardest by the nation's No. 1 killer. Mississippi tops the list. The American Heart Association released its annual look at heart disease in America on Friday, ahead of a January publication of the findings in the medical journal Circulation.

Cardiovascular disease accounted for more than one-third of all deaths in 2004, the most recent year for which data is available, but there are signs of improvement.
Mississippi had the highest fatality rate from cardiovascular disease and coronary heart disease, at nearly 406 deaths per 100,000 people.
Oklahoma was next, with nearly 401 deaths per 100,000; Alabama, with 378 deaths; Tennessee, with nearly 374 deaths per 100,000; and West Virginia, with 373.
There were twice as many angioplasties recorded in Southern states as compared to other regions, and the report found similar ratios of bypass surgery, open-heart surgeries and pacemaker implants.
Wayne Rosamond, an epidemiologist at the University of North Carolina and the chairman of the American Heart Association Statistics Committee, said there are studies now directed at finding out exactly why heart disease has such striking regional differences.
"What drives those shifts is not really well understood," he said.
West Virginia fared slightly better in fatality rates from stroke, ranking ahead of 12 others. The report found that 373 people per 100,000 die from cardiovascular disease in West Virginia, down one from the previous year.
While that may seem like modest progress, the state's death rate has dropped since 1993, when the death rate was 390 out of every 100,000 West Virginians.
Rosamond said signs like that are positive indicators.
"There are a lot of things going on that are good, particularly on the prevention side," Rosamond said.
In particular, he cited a drop in smoking rates among young people and a growing awareness of heart disease among women as signs that prevention efforts are beginning to make a dent in the mortality rate.
Those kinds of changes take years to show up in statistics, though, according to Dr. Anthony Morise, a cardiologist and professor of medicine at West Virginia University.
"You have to get people in a preventive mode," he said. "Those things take a while to translate into a measurable change."
Morise also said he's noticed improvements in the diagnosis and treatment of women, for whom heart disease is the most common fatal illness. Women with heart disease commonly exhibit symptoms not usually found in men, such as unexplained fatigue, and often don't show symptoms like crushing chest pain.
The fact that doctors have gotten better at identifying those symptoms, and patients have grown more aware of what they might be, means that diagnosis has gotten better, Morise said. At the same time, though, as diagnosis improves, heart disease rates will show an increase.
"The more we detect it, the more the incidence rates will go up," he said.
In addition to focusing on heart disease in demographic groups like women and Latinos, the report also underscores the need to study why it is so much more common in the South than in the rest of the country.