OBJECTIVES:  To determine if there are geographic disparities in behavioral risk factors for coronary heart disease in Appalachian versus non-Appalachian portions of Appalachian states.  METHODS:  Using Behavioral Risk Factor Surveillance System (BRFSS) data from 2000 to 2005, county codes were utilized to identify resident locations for 1,567,206 respondents residing in states that are located partly (twelve states) or entirely (one state) within the Appalachian region, as designated by the Appalachian Regional Commission.  Prevalence of modifiable risk factors of cardiovascular disease (obesity, physical inactivity, low intake of fruit and vegetables, and smoking) in the Appalachian portions of states was compared to that in the non-Appalachian portions.  Chi square tests were utilized to test for significant differences.  RESULTS:  Overall, obesity rates were higher in the Appalachian region compared to the non-Appalachian region.  When compared within each individual state, obesity rates were significantly higher in the Appalachian portion compared to the non-Appalachian portion in seven states.  Overall, fewer respondents participated in leisure time physical activity in the Appalachian region, and this trend held in eight states.  Respondents in the Appalachian region were less likely to eat five or more servings of fruits/vegetables per day, and this trend held in nine states.  Finally, more subjects reported smoking every day in the Appalachian region, which held true in ten states.  Gender differences in the Appalachian region mirrored the trends in non-Appalachian areas. Prevalence of physical inactivity was higher in women, as was daily consumption of the recommended amount of fruits and vegetables. Smoking rates were generally higher in men.  CONCLUSIONS:  In general, the Appalachian region was associated with higher prevalence of modifiable risk factors for coronary heart disease, possibly explaining the increased burden of heart disease in this population.  These data highlight a culture of poor diet and sedentary lifestyle prevalent in Appalachian populations.