Deaths from cardiovascular disease — the nation's No. 1 killer — continued to drop in the Islands in 2005 but Filipinos and people on the Big Island still saw inexplicably higher death rates.

Overall, more than 2,900 people died in Hawai'i in 2005 from cardiovascular disease — an umbrella term for heart attacks, stroke, high blood pressure and other related diseases and symptoms. Their deaths accounted for more than a third of all fatalities in Hawai'i, according to a study released yesterday by the state Health Department.

Hospitalizations related to cardiovascular disease accounted for more than $604 million, according to the report, "The Burden of Cardiovascular Disease in Hawaii 2007."

The study was the first of its kind in Hawai'i since 1997 and included data for the year 2005 only.

It found that Filipinos had a higher death rate from major cardiovascular disease — 396.3 per 100,000 people — than all ethnic groups. Filipinos were followed by Native Hawaiians with a rate of 313.1 per 100,000 people.

Hawai'i County had more cardiovascular-related deaths than any other. Poorer people also continued to die more frequently from cardiovascular disease.

Overall, however, Hawai'i continues to follow the national trend toward fewer people dying of cardiovascular disease.

The Islands saw a more than 24 percent drop in cardiovascular disease deaths between 1994 and 2004, according to the American Heart Association, ranking Hawai'i third best in the country behind Minnesota and Alaska.

While progress is clear, people in Hawai'i still need to do better with their diets, exercise and dealing with stress, according to Dr. Stephen Bradley, the state's only board certified bariatrics specialist who also specializes in disparate weight issues at various hospitals and the Wai'anae Coast Comprehensive Health Center.

"The progress has come from a number of fronts and reducing smoking is definitely helping," Bradley said. "On the other side, how come everybody isn't doing better? In general, it's an unhealthy American lifestyle. We're fighting an incoming tide."

Related diseases that have afflicted groups such as Native Hawaiians since Western contact have been well documented. But the cardiovascular-related mortality rate for Filipinos in Hawai'i, Bradley speculated, may also be the result of replacing relatively healthy foods with high-fat, high-cholesterol, fast-food diets.

"Where the traditional Filipino lifestyle may have been based around fish, lots of vegetables and complex carbohydrates, the stress level has definitely changed, and the overall lifestyle changed fairly rapidly here. The high cost-of living only mushrooms that."

Bradley also speculates that the Big Island's death rate, like other rural communities', may be connected to poorer, less-educated populations that don't have sophisticated healthcare systems.

"Rural areas have a culture of poverty and eating poorer foods that are high in fat and cholesterol," Bradley said. "And when you lack preventative care, these kinds of things tend to occur."

Dr. Chiyome Fukino, state Health Department director, hopes her staff receives federal money to conduct similar studies before another decade passes.

In the meantime, she expects that the latest study will be reviewed by healthcare professionals and individual communities.

'I WAS EATING JUNK'

At the age of 27, Nancy Alapai worked as a nutrition counselor at the Wai'anae Coast Comprehensive Health Center but carried more than 300 pounds on her 5-foot-7 frame.

"I was a nutrition counselor teaching people how to eat right, but I wasn't doing it myself," Alapai said. "I was eating junk: fried foods, fast foods, candies, cookies, all these things that we call good."

She's Hawaiian-Portuguese with a family history of cancer and heart disease.

"My mom passed away from cancer at only 40 when I was 18, then my dad had heart surgery bypass when I was 21," Alapai said. "He died three years ago of cancer. I knew that being overweight could lead to those things if I didn't do anything about it."

So Alapai started eating better and working out regularly and dropped more than 130 pounds in over a year. Today, at 36, Alapai runs three or four miles every other day, works out with machines and weights and does kick boxing and step aerobics.

And for the past three years, Alapai has been a personal fitness trainer who also helps patients manage their chronic diseases.

Looking back, she can see that much of their problems can be traced to lack of exercise and diets that rely on "all those saturated things like Spam, sausages and hot dogs."

"I guess I was in denial," she said. "Now I feel good."

Reach Dan Nakaso at dnakaso@honoluluadvertiser.com.