Abstract: Metabolic cardiovascular disease comprises a spectrum of conditions driven by the long-term accumulation of obesity, elevated blood pressure, dyslipidemia, glucose metabolism disorders, and related kidney and vascular damage. Increasing evidence indicates that its risk does not begin only in middle or older age but extends from preconception and pregnancy to childhood, adolescence, and young adulthood. Maternal obesity, gestational diabetes, hypertensive disorders of pregnancy, nutritional imbalance, smoking, and air pollution may impair fetal cardiovascular, renal, and metabolic development through placental dysfunction, inflammation, oxidative stress, endocrine and metabolic reprogramming, and epigenetic regulation, thereby increasing the offspring’s risks of elevated blood pressure, obesity, insulin resistance, and adult cardiovascular disease. After birth, body mass index, blood pressure, blood lipids, blood glucose, smoking, physical inactivity, air pollution, and malnutrition may follow four trajectories: persistently favorable, favorable-to-unfavorable, unfavorable-to-favorable, or persistently unfavorable, shaping adult cardiometabolic risk. This review synthesizes evidence from the developmental origins of health and disease theory, international cohorts, animal models, twin studies, and the Hanzhong Adolescent Hypertension Study, and proposes prevention strategies centered on early screening, trajectory identification, comprehensive intervention, and continuous follow-up.