Last Updated: February 3, 2005, 05:28:26 AM PST

The death rate from heart disease is higher in Stanislaus County than in any of California's other 57 counties.

Coronary disease annually kills 238 people in the county per 100,000 population, according to statewide health status figures for 2004. The rankings are derived from data compiled by the state Department of Health Services.

Merced County has the ninth-highest mortal-ity rate, while San Joaquin County is 11th and Tuolumne County is 22nd.

Since 2000, Stanislaus has been among the six counties with the highest heart disease mortal-ity, but this is the first time it has held the worst ranking.

The county's Health Services Agency cited the figures Wednesday in announcing new efforts to make the public aware of heartdisease risk factors such as poor diet, lack of exercise, smoking and obesity.

Dr. John Walker, the county's public health officer, said the agency is concerned about the trend and hopes the latest figures will convince people to adopt healthier lifestyles.

"I don't think the numbers are a reflection on our health care system, per se," he said. "But I am very concerned about the lifestyle issues."

County records going back 13years show that the rate of heart-related deaths is highest among African-Americans, sometimes more than double the rate for whites.

Still, the county's white population suffers heart-related deaths at a rate far higher than state or national averages.

Latinos and Asians have heart-related mortalities closer to the state and national averages, according to county figures.

County health officials have never determined what causes the high rates here. But one condition on which they plan to focus more attention is adult-onset diabetes, also known as Type 2 diabetes, which is at epidemic proportions in the Central Valley.

The disease, which usually manifests itself in adults, most commonly results from obesity and sedentary living.

Dr. Vance Roget, a Modesto rehabilitation physician and member of the county's Heart Coalition, said people with Type 2 diabetes have heightened cholesterol levels. In addition, the disease leads to inflammation of heart arteries, causing the formation of plaque that restricts blood flow and leads to heart attacks.

The county health agency also is taking aim at tobacco use. While smoking is less prevalent in California than anywhere in the nation, Stanislaus County has not followed the trend, Walker said.

Officials are concerned that young people increasingly have access to cigarettes. The county's Tobacco Coalition sent underage decoys into stores and found they were able to buy cigarettes 26 percent of the time. That was double the sales rate recorded in a previous decoy operation.

Officials have considered a policy change that would require businesses that sell tobacco products to get a county license.

Penalties, including license revocation, could be assessed if businesses were caught selling to minors. No proposal has gone to the Board of Supervisors.

Some people have also questioned whether dirty air is linked with heart disease in the Northern San Joaquin Valley. Other counties with high incidence of heart-related deaths are in Southern California, which is known for smog.

Walker said he has not seen evidence that air pollution causes heart disease, but he said it is a known stress factor in heart attacks and strokes.

To get the message out to the public, the county has relied on a Heart Coalition made up of volunteers from hospitals, insurance companies and nonprofit groups, and education figures.

Last year, coalition members went to schools and led students in health education activities. This year, they plan to shoot for a large adult audience by giving presentations to employers.

Phoebe Leung, the Health Service Agency's director of health promotions and former coalition president, said members will urge companies to:

Provide exercise breaks for employees.

Promote healthy foods in the workplace, whether in the cafeteria, vending machines or at company potlucks.

Publish wellness newsletters and coordinate presentations for employees on healthy living.

Offer incentives to employees, such as discounted health club memberships or paying for employees to attend health education classes.

Despite the county's track record with heart disease, Walker said, the agency has been unable to obtain grants for a more concerted prevention program.

County Supervisor Bill O'Brien said that's consistent with a pattern of the county getting shorted on funding from the state.

"I think that improving your health comes down to personal responsibility," he said, "but I think there should be more funding for (health) education."

Even if the coalition is on target with its education program, it will likely take several years to see results.

"It's hard to get people to want to make changes and then make the changes," Roget said.

Companies interested in hosting a health presentation for employees may call the Heart Coalition of Stanislaus County, 209-558-5657.

Bee staff writer Ken Carlson can be reached at 578-2321 or kcarlson@modbee.com