In this large prospective cohort study of 35,189 nulliparous women in Sweden, pregestational cardiometabolic biomarkers measured a median of 4 to 6 years before pregnancy were associated with subsequent risk of hypertensive disorders of pregnancy (HDP), which occurred in 5.5% of participants. Higher levels of multiple lipid markers—including apolipoprotein B, LDL cholesterol, total cholesterol, triglycerides, and the ApoB/ApoA1 ratio—as well as haptoglobin and the triglyceride-glucose index were associated with increased odds of HDP, while C-reactive protein and leukocyte count were not. Notably, elevated risk was observed even at subclinical levels below standard diagnostic thresholds, and associations for several lipid markers appeared largely linear across their range. These findings suggest that cardiometabolic risk factors present years before pregnancy may contribute to HDP risk and could have implications for earlier risk identification.