Background: Childhood cancer survivors (CCS) are at increased risk of cardiovascular (CV) disease. We assessed the burden of potentially modifiable cardiometabolic risk factors among young adult CCS vs population-matched controls. Methods: CCS who enrolled on Pediatric Oncology Group protocols 9404, 9425, 9426, and 9754 from 1996-2001 with acute lymphoblastic leukemia/lymphoma, Hodgkin lymphoma, and osteosarcoma were prospectively assessed for prevalence of obesity, hypertension, dyslipidemia, diabetes, and lifestyle habits (smoking, physical activity) in CCS vs an age-, sex-, and ethnicity-matched 2013 NHANES population. We then estimated Framingham and PDAY general CV risk scores for both groups, and for CCS we also estimated CV risk scores published by the Childhood Cancer Survivor Study (CCSS). Results: Compared with NHANES (n = 591), CCS (n = 109; 43% female, mean age 28y; 16y since diagnosis; mean doxorubicin dose 286 mg/m²; 39% chest radiation, mean 23 Gy; 54% dexrazoxane exposed) had similar rates of obesity (26 vs 30%, p = .73), hypertension (35 vs 31% p = .46), hyperglycemia (12 vs 18%; p = .17), dyslipidemia (49 vs 46%; p = .55), and metabolic syndrome (ATP3 criteria: 12 vs 17%; p = .19). More CCS met Centers for Disease Control & Prevention’s guidelines for physical activity (69 vs 45%; p < .001) and fewer reported a history of smoking (27 vs 45%; p = .002). Results were similar among CCS recruited from sites with > 50 vs < 50% participation in this analysis. Because of lifestyle differences, Framingham and PDAY risk scores were generally higher for NHANES vs CCS. Applying the CCSS risk scores, 39% of CCS were at moderate risk of ischemic heart disease, and > 95% at moderate or high risk for heart failure corresponding to a 9-12% predicted incidence of these conditions by age 50. Conclusions: Young adult CCS exhibited similar cardiometabolic profiles as NHANES. With more favorable lifestyle habits, CCS had lower predicted CV risk per general risk models but a high proportion had moderate or greater risk of CV disease predicted by the CCSS risk models. Further analyses are needed to determine the impact of dexrazoxane on CCS-specific CV risk. However, the favorable lifestyle habits of this cohort provide cause for optimism.