The Far West and Orana region in the west of New South Wales has recorded the state's second highest rate of death from coronary heart disease.
The region is second to New England and North West for heart attack deaths in the latest statistics from the Heart Foundation.
Director of health strategy Julie Anne Mitchell said the results reflected a divide between city and country areas.
"Unfortunately, where you live, your postcode, really does determine your heart health to some extent," Ms Mitchell said.
Far West and Orana spans 16 Local Government Areas including Dubbo, Broken Hill, Gilgandra and Bourke.
The rate of death from heart disease across the Far West and Orana was more than 30 per cent above the state average.
The region ranked sixth in the state for heart attack hospitalisations.
Highest rates of heart disease risk factors: smoking and obesity
Far West and Orana had the highest rates of adult obesity and smoking in New South Wales, according to the Heart Foundation data.
Across the region 44 per cent of adults were obese, which was more than double the rate of obesity of North Sydney and Hornsby, on the state's east coast.
More than 20 per cent of the Far West and Orana population were smokers, with the rate of smoking in the region 50 per cent higher than the state average.
Far West and Orana also fell within the top 10 out of 28 regions across the state for physical inactivity and high blood pressure.
Services 'not as good as they could be'
Ms Mitchell said a lack of health services in rural and remote areas was one of the factors that contributed to higher rates of heart disease deaths.
"We have an ageing population, particularly in rural and remote areas [and] we know that services are not as good as they could be," she said.
"There are long waiting times to get in to see a GP, hospitals are more sparsely situated across rural and regional areas.
"Then simple things like access to really good quality fresh food is much more limited in rural areas and so, in turn, that has an impact on your lifestyle."
Ms Mitchell said "the burden of heart disease" fell hardest on Aboriginal and Torres Strait Islander people.
She encouraged people living in regional and rural parts of New South Wales to participate in an ongoing NSW Upper House Inquiry that will compare health outcomes for people in the bush with city dwellers.
"There's never been a better time to make your voice heard about how services could be improved in your local area," Ms Mitchell said.
