Since the mid-1990s, the death rate from heart disease has dropped faster in Minnesota than in any other state -- a whopping 45 percent, according to a new report from the American Heart Association.

The report, which was quietly released in December, ranks Minnesota at the top of the nation in what has been one of the great success stories of modern medicine.

Nationwide, the death toll from heart disease has been falling steadily for a quarter-century, largely because of improved treatments and lifestyle changes.

But Minnesota's progress has outshined the rest of the country. In the latest ranking, published in the Heart Association's 2008 national report, the state had the lowest rate of death from coronary heart disease: 90 per 100,000 population, compared with a nationwide average of 150 in 2004, the latest data available.

And Minnesota had the lowest death rate from all cardiovascular disease (including heart disease, stroke and related conditions): 211 per 100,000 population, compared with a nationwide average of 288.

It is, experts say, a testament to healthy living and a top-rate medical system.

But they also say that the news would be better if more people heeded their advice on diet, exercise and smoking.

"Just because we're good doesn't mean we can't get better," said Stanton Shanedling, head of heart disease and stroke prevention at the Minnesota Department of Health.

Cardiovascular disease remains the nation's leading killer, causing more than 850,000 deaths in 2004, according to the Heart Association. (In Minnesota, only cancer kills more people every year.)

For some, though, Minnesota's success against heart disease comes as no surprise.

"I think it's the culmination of a lot of good things happening over the past decade or more," said Dr. Russell Luepker, a University of Minnesota cardiologist and a board member of the Heart Association's Twin Cities chapter. In fact, he said, Minnesota has long ranked among the best in the country. "We've always been in the top four or five for as long as I can remember," he said.

Why? Among other things, studies show that Minnesotans are more health-conscious than average: They tend to smoke less, be more active, and do a better job with their blood pressure and cholesterol rates.

"It's probably starting to sink into people's psyches that these are the things you should do to stay healthy," Shanedling said.

In addition, more Minnesotans have health insurance than the national average, Luepker said. "So they can go to the doctor and they can get taken care of," he said.

And the experts agree that Minnesota is known for its medical care. "We have very good clinical services," Shanedling said. "I mean, some of the best in the country."

That combination of "high quality care" and insurance means that most Minnesotans have access to the latest drugs and treatments, said Dr. Thomas Kottke, a cardiologist at Regions Hospital in St. Paul, who coauthored a 2007 study on the declining death rate.

That high level of care makes a difference. "We know, for example, that after a heart attack, staying on the right drugs lowers mortality rates 80 to 90 percent," he said. "That's huge."

Yet, Kottke added, "that's not to say there aren't disparities."

Even though Minnesota came out on top, "we still have problems," Shanedling said. Some ethnic groups -- such as African Americans and American Indians -- have higher death rates because of disparities in access to care and other factors, he said. And there are some ominous signs for the population as a whole.

"Things like obesity are going to catch up with us, and they're starting to already," Shanedling said. "Since 1990, the prevalence of obesity in the state of Minnesota has increased 142 percent. Now that's alarming."

Kottke, the Regions cardiologist, agrees.

"Most of the problems I see, as a practicing cardiologist, are due to things that people should have learned in the eighth-grade health class," Kottke said. In other words: exercise, don't smoke and eat a healthful diet.

And that remains a challenge, he said, even if Minnesota is the best in the nation.

"I mean, it's great," he said. "But we could do so much better."

Maura Lerner • 612-673-7384