Urban–rural differences in cardiovascular health among young adults in the Turkestan region of Kazakhstan

Background: Cardiovascular disease (CVD) remains a major global health challenge, and early action among young populations is critical. The aim of this study was to assess cardiovascular health among young adults aged 18-44 years in the Turkestan region using the American Heart Association Life's Essential 8 (LE8) framework and to explore health care workers' perspectives on determinants of cardiovascular health and primary health care (PHC) strategies for prevention. Methods: ) tests, respectively. In the qualitative component, semi-structured interviews were conducted with PHC nurses involved in preventive and screening programs. Interviews continued until thematic saturation was achieved and were analyzed using conventional thematic content analysis. Results: A total of 843 young adults participated in the study (urban: 432; rural: 411), including 289 males (34.3%) and 554 females (65.7%). Most participants had intermediate cardiovascular health (67.6%), while 28.9% had high and 3.4% had poor cardiovascular health according to the LE8 framework. Rural participants reported a healthier diet, higher physical activity, and longer sleep duration but also had substantially higher smoking prevalence and obesity. Urban participants achieved higher overall LE8 scores, largely due to lower tobacco exposure. Females, particularly in urban areas, had more favorable cardiovascular health profiles, with better smoking and sleep scores and higher overall LE8 scores than males. Interviews with seven PHC nurses indicated that cardiovascular risk factors increased after the age of 40, were more common among men, and were influenced by cultural, behavioral, and economic factors. Nurses emphasized the need to strengthen workplace- and community-based cardiovascular prevention programs. Conclusion: Most young adults in the Turkestan region demonstrated moderate cardiovascular health; however, modifiable cardiovascular risk factors remain common. These findings support the implementation of gender-specific and region-specific cardiovascular prevention strategies, culturally tailored lifestyle interventions, tobacco-control measures, and earlier cardiovascular screening within PHC settings.