The mortality rates from ischaemic heart disease in the Hunter Region of New South Wales are among the highest in Australia. Within the Region substantial differences occur in death rates from heart disease among the five urban local government areas, the highest being in the coal-mining district of Cessnock and the lowest in the resort and dormitory area of Port Stephens. A recent survey in the Region of risk factors for heart disease has revealed prevalence patterns for high blood pressure, serum cholesterol levels, smoking and overweight and obesity which largely parallel the pattern of heart disease mortality. This suggests that changes in life-style in the communities could reduce the intraregional differences in mortality. In addition, the widespread prevalence of an unhealthy diet and a lack of exercise may explain the Region's high death rates from heart disease and suggests that mortality could be reduced by effective preventive measures.