MONDAY, May 19 (HealthDay News) -- Women who want to keep their hearts in tip-top shape face the fewest challenges in Minneapolis, Washington, D.C., and San Francisco.

Those three cities top the list of the 10 most heart-healthy U.S. metropolitan areas for women, a list that's dominated by western communities.

But the list, released Monday by the American Heart Association, also found the 10 metropolitan areas -- mostly in the South and the Midwest -- that spell trouble, with Nashville, Tenn., St. Louis and Detroit deemed the least friendly major cities for women's heart health.

"It's fair to say that if you live in the least heart-healthy cities, there's a chance that you'll have a high (likelihood) of heart disease and stroke and may have a shortened lifespan," said Dr. Jennifer Mieres, a spokeswoman for the American Heart Association and director of nuclear cardiology at the New York University School of Medicine.

Heart disease is the leading killer of American women. An estimated one-third of women suffer from heart problems, according to the American Heart Association, which says cardiovascular disease kills more women than the next five most common causes of death combined.

The heart association's "Go Red For Women" campaign commissioned Sperling's BestPlaces, which ranks the best places to live in the United States, to conduct the study. It included an analysis of 22 factors affecting women's heart health, including rates of cardiovascular mortality, high blood pressure, exercise, and smoking.

The review, which also looked at factors like stress levels and the numbers of people who commute by bicycle or on foot, encompassed the 200 largest metropolitan areas in the country.

The most heart-friendly metro areas for women are:

1. Minneapolis-St. Paul-Bloomington, Minn.
2. Washington-Arlington-Alexandria, District of Columbia
3. San Francisco-San Jose-Oakland, Calif.
4. Denver-Aurora, Colo.
5. Boston-Cambridge-Quincy, Mass.
6. Seattle-Tacoma-Bellevue, Wash.
7. Portland-Vancouver-Beaverton, Ore.
8. San Diego-Carlsbad-San Marcos, Calif.
9. Los Angeles-Long Beach-Santa Ana, Calif.
10. Phoenix-Mesa-Scottsdale, Ariz.

Minneapolis-St. Paul, Boston and Phoenix have the lowest heart-disease mortality rates for women, while women in San Francisco, Denver and Los Angeles are the thinnest.

Women in San Francisco, San Diego and Washington, D.C., are the healthiest eaters, and those in Sacramento, Los Angeles and San Francisco smoke the least.

The least-friendly metropolitan areas for women are:

1. Nashville-Davidson-Murfreesboro, Tenn.
2. St. Louis, Mo.
3. Detroit-Warren-Livonia, Mich.
4. Pittsburgh, Pa.
5. Dallas-Fort Worth-Arlington, Texas
6. Columbus, Ohio
7. Cincinnati-Middletown, Ohio
8. Las Vegas-Paradise, Nev.
9. Cleveland-Elyria-Mentor, Ohio
10. Indianapolis, Ind.

The researchers reported that women in Cleveland, Columbus, Ohio, and San Antonio, Texas, are among the most overweight in the country.

Women smoke the most in Cincinnati, Nashville and Indianapolis, while they eat the least healthy food in St. Louis, Kansas City, Kan., and Milwaukee.

The heart-unhealthy cities seem to share some things in common, Mieres said, like a plethora of fast-food restaurants, a tendency for people to drive instead of walk, and high smoking rates.

They may also have fewer teaching hospitals and fewer doctors per capita, she said. "When you look at the middle of the country and the South, they are about a decade or five years behind in getting the message that simple changes in diet and activity can have an impact," she said.

However, living in one of these 10 cities doesn't guarantee an unhealthy future, Mieres said. "What we're trying to do is to get women across the country to recognize that whether or not you live in a heart-friendly city, heart disease can be prevented."

Dr. Nieca Goldberg, medical director of the Women's Health Program at New York University Medical Center, agreed. "The wrong take-away message is that you would have to move to prevent heart disease," she said.

Another cardiologist, Dr. Lori Mosca, director of preventive cardiology at New York-Presbyterian Hospital/ Columbia University Medical Center, said future studies should look at factors like air quality, bans on trans fat in restaurants, and the availability of fresh produce in inner cities.

"These are some of the environmental factors that may have a significant influence on heart disease that are within the social and political control of cities," Mosca said.

But the best advice remains: Eat healthy, get physically active, and track your blood pressure, cholesterol, glucose and weight and keep them in a healthy range.

More information

Learn more about heart disease in women from the American Heart Association.

SOURCES: Jennifer Mieres, M.D., spokeswoman, American Heart Association, and director, nuclear cardiology, New York University School of Medicine, New York City; Nieca Goldberg, M.D., medical director, Women's Health Program, New York University Medical Center, New York City; Lori Mosca, M.D., Ph.D., director of preventive cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York City; May 19, 2008, news release, American Heart Association

Copyright © 2008 ScoutNews, LLC. All rights reserved.