Abstract Introduction Urbanization is an important contributor to atherosclerotic cardiovascular disease (ASCVD) in the Middle East, especially in the younger age groups. There is a scarcity of data on clinical profiles and cardiovascular risk factors (RFs) in urban young women compared with those who reside in rural areas in this region. Purpose To study the demographic and clinical profiles and prevalence of traditional and novel CV RFs in a cohort study of young urban Middle Eastern women compared with those in rural areas. Methods The prevalence of 19 traditional and novel cardiovascular RFs were compared in urban vs. rural young women residents (18-50 years of age), who were enrolled in 12 centers (August 2020 to October 2023). Results Of 627 young women enrolled (mean age 44.2 ± 5.1 years old), 463 (74%) were urban residents and 164 (26%) were rural residents. ASCVD was diagnosed in 32% of urban and 37.3% of rural young women. Table shows the prevalence of traditional and novel, sex-specific RFs with significant differences in the 2 groups. Other RFs with no significant differences included hypertension, diabetes and gestational diabetes, preterm delivery, persistent weight gain after delivery, radiation for breast cancer, and polycystic ovary syndrome. Conclusion In this cohort of Middle Eastern young women, despite heterogeneity, those who were urban residents had worse clinical profiles with higher prevalence of certain classical and sex-specific risk factors.