Heart disease is the leading cause of death for both men and women in the United States. However, some of the highest rates of heart disease are in Appalachian areas - the highest percentage in the country and twice the national average. There are many different factors to explain why this percentage of heart disease is so high, individuals living in Appalachian areas face demographic, geographic, and environmental factors that have been linked to the risk of heart disease. In order to reduce the prevalence of heart disease in Appalachia, primary, secondary, and tertiary prevention must all be involved. Through health promotion, adoption of healthy lifestyles, early identification and treatment, and adequate treatment and rehabilitation, Appalachians can reduce their risk of heart disease.