Background: Microalbuminuria, an early indicator of renal damage, is increasingly recognized as a marker for cardiovascular risk. Aim and Objective: This study aims to evaluate the association between microalbuminuria and cardiovascular risk factors in pre-diabetic and pre-hypertensive patients. Methods: A case-control study was conducted with 150 pre-diabetic and 150 pre-hypertensive patients, compared to age- and sex-matched controls. Participants underwent comprehensive assessments including anthropometric measurements, blood pressure monitoring, fasting blood glucose, serum lipid profiles, and urine albumin-to-creatinine ratio (ACR). Statistical analyses included ANOVA, post-hoc Tukey’s tests, multiple linear regression, and logistic regression. Results: The prevalence of microalbuminuria was significantly higher in pre-diabetic (45%) and pre-hypertensive patients (48%) compared to controls (15%). ANOVA revealed significant differences in mean ACR across quartiles of systolic blood pressure, BMI, and fasting blood glucose, with higher levels associated with increased ACR. Logistic regression showed that pre-diabetes and pre-hypertension were significant independent predictors of microalbuminuria, with odds ratios of 2.73 and 3.24, respectively. The combined presence of both conditions increased the odds to 4.86.