Our objective was to determine the relationship between socioeconomic and psychological factors and comprehensive cardiovascular health (CVH), defined according to Life's Essential 8 (LE8) of the American Heart Association, in young adults in Puerto Rico. 2,156 young people between 18 and 29 years of age enrolled in the PR-OUTLOOK study participated. The analysis included survey data, laboratory tests and physical measurements collected between September 2020 and November 2023. The socioeconomic indicators evaluated included food insecurity, housing instability, economic insecurity and the subjective perception of social status. The psychological factors analyzed included symptoms of depression, anxiety, post-traumatic stress disorder, and general perceived stress. The LE8 scores were calculated and classified as suboptimal CVH (poor/intermediate range) versus ideal. Using logistic regression models, the associations between each socioeconomic and psychological factor and suboptimal CVH were estimated; in addition, a dominance analysis determined the relative relevance of each variable. The average age of the participants was 22.6 years (SD = 3.1), 60.9% were women, approximately one third (34.2%) had secondary education or lower, and more than a third had public insurance or no health insurance (38.4%). Those who reported socioeconomic adversities (high food insecurity, housing instability, economic insecurity, and low subjective perception of social status) and high psychological symptoms (anxiety, depression, post-traumatic stress, and perceived stress) had lower CVH scores. However, in the adjusted analysis, only low subjective perception of social status (OR = 1.38, 95% CI = 1.13—1.69), as well as high anxiety symptoms (OR = 1.63, 95% CI = 1.25—2.13) and depression (OR = 1.30, 95% CI = 1.03—1.65) were highlighted as the main contributors to suboptimal versus ideal CVH. Conclusion: Initiatives to preserve and improve cardiovascular health in Puerto Rican youth should focus on these factors.