Background We investigated how childhood‐to‐adulthood perceived stress patterns predict adult cardiometabolic risk. Methods and Results This study included 276 participants from the Southern California Children's Health Study (2003–2014), and a follow‐up assessment (2018–2021). Perceived stress (Perceived Stress Scale) was initially reported by participants' parents for themselves during early childhood (mean age, 6.3 years), and later self‐reported during adolescence (13.3 years) and young adulthood (23.6 years). Participants were grouped into 4 stress patterns: consistently high, decreasing, increasing, and consistently low. Cardiometabolic risk was assessed in young adulthood by carotid artery intima‐media thickness, systolic and diastolic blood pressure, obesity, percent body fat, android/gynoid ratio, and glycated hemoglobin. A cardiometabolic risk score was generated by summing the clinically abnormal markers. Multivariable linear and logistic regression models were used to (1) examine the associations between Perceived Stress Scale at 3 time points and adult cardiometabolic risk, and (2) assess the impact of stress pattern on adult cardiometabolic risk. Findings suggested that in adulthood, higher Perceived Stress Scale score was associated with increased overall cardiometabolic risk (β=0.12 [95% CI, 0.01–0.22]), carotid artery intima‐media thickness (β=0.01 [95% CI, 0.0003–0.02]), systolic blood pressure (β=1.27 [95% CI, 0.09–2.45]), and diastolic blood pressure (β=0.94 [95% CI, 0.13–1.75]). Individuals with a consistently high adolescence‐to‐adulthood stress pattern had greater overall cardiometabolic risk (β=0.31 [95% CI, 0.02–0.60]), android/gynoid ratio (β=0.07 [95% CI, 0.02–0.13]), percent body fat (β=2.59 [95% CI, 0.01–5.17]), and greater odds of obesity (odds ratio, 5.57 [95% CI, 1.62–19.10]) in adulthood, compared with those with a consistently low Perceived Stress Scale score. Conclusions Consistently high perceived stress from adolescence to adulthood may contribute to greater cardiometabolic risk in young adulthood.