Cardiometabolic diseases are among the leading causes of mortality worldwide and are increasing in prevalence in rapidly aging populations. The socioeconomic position (PSE) of the neighborhood and the composition of the household have become increasingly important as determinants of cardiometabolic health, although their analysis in Puerto Rico has been scarce. This study explored the association between neighborhood PSE, forms of living together and the incidence of cardiometabolic conditions in older adults living on the island, using longitudinal data from the Puerto Rican Elderly Health Conditions Project (Oleadas I 2002/03 and II 2006/07), linked to census information from 2000 at the neighborhood level. The sample included non-institutionalized adults aged 60 years or older who stayed in the same residence during both periods (N = 2,769). Multilevel multinomial logistic regression models were applied to analyze the relationship between neighborhood PSE and the prevalence and incidence of cardiometabolic diseases. The results indicate that living in a socioeconomically favored neighborhood was positively associated with the presence of at least one cardiometabolic condition at the beginning, but not with the incidence of such conditions during follow-up. Living without a partner was negatively associated with the presence of cardiometabolic diseases compared to living accompanied by a partner. Similar findings were observed regarding the incidence of these conditions. The composition of the household significantly modified the relationship between neighborhood PSE and cardiometabolic health. In contrast to living with a partner, residing only in a socioeconomically privileged neighborhood was associated with a lower risk of reporting a condition. In addition, living with children in a favorable socioeconomic environment correlated with a reduced risk of developing a cardiometabolic condition compared to living with a partner. The structure of the household proves to be a more determining factor for cardiometabolic health than the socioeconomic position of the neighborhood. It is imperative to design social programs and services that consider family composition to identify Puerto Rican older adults at potential risk of underdiagnosed chronic conditions, especially in the face of economic, demographic, environmental and health crises that threaten to aggravate social inequalities.