Abstract Body: Introduction: Cardiovascular disease (CVD) is a key driver of cardiovascular-kidney-metabolic multimorbidity (CKMM) and mortality. Transgender adults appear to face a higher prevalence of CVD risk factors than cisgender peers, but their elevated risk correlates with CKMM remain unclear. This study examines the association between CKMM and transgender identity. Methods: We used nationally representative data from the 2017-2022 Behavioral Risk Factor Surveillance System, including adults aged ≥18 with gender identity data. The primary outcome was CKMM (yes/no), defined as CVD (coronary heart disease, stroke, or myocardial infarction), chronic kidney disease, and metabolic risk factors (BMI ≥ 25 kg/m2 or diabetes mellitus). Multivariable logistic regression models assessed the odds of CKMM, with transgender status as the main independent variable. Covariates included sociodemographics, behavioral risk factors, BMI, age, and age-gender interaction. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported, accounting for complex survey design. Results: The study included 649,106 transgender adults (median age 33 years, IQR 22-53), consisting of 347,539 transgender men and 301,577 transgender women. About 61% of transgender adults exhibited ≥1 CKMM feature, overweight/obesity being the most common. Transgender adults had a threefold higher likelihood of CKMM compared to cisgender peers (aOR 3.09, 95% CI, 1.73-5.52; p<.001). Elevated CKMM odds in transgender adults were driven by significantly higher rates of myocardial infarction, stroke, coronary heart disease, and chronic kidney disease. Age was the only significant predictor of CKMM in transgender adults, while multiple factors—BMI, health coverage, physical activity, heavy drinking, income, and employment—were significant for cisgender adults. A significant age-transgender status interaction (p<.001) demonstrated that transgender adults had a higher predicted probability of CKMM across the age continuum with risk convergence around 80 years. For example, the predicted probability of CKMM in a 22-year-old transgender adult was equivalent to that of a 66-year-old cisgender adult. Conclusion: CKMM is strongly linked to transgender identity, with transgender adults facing higher risks at substantially younger ages. This underscores the need for improved screening and preventive measures in transgender populations to address early onset of CKMM and reduce premature morbidity and mortality.