Background: While both sarcopenia and obesity independently elevate cardiovascular disease (CVD) risk, their combined effects, known as sarcopenic obesity (SO), remain incompletely understood. This systematic review and meta-analysis aimed to evaluate the association between SO and the risk of CVD and CVD-related mortality.

Methods: A comprehensive search of scientific databases was conducted from inception to May 2025, including observational studies assessing SO in relation to incident CVD or CVD mortality. Pooled odds ratios (ORs) with 95% CIs were calculated using random-effects models. Subgroup analyses examined variations by age, sex, geography, study design, and CVD subtypes, with P-values for interaction being assessed.

Results: Sixteen studies involving 578 408 participants were included. Sarcopenic obesity was significantly associated with a 95% higher CVD risk (OR = 1.95, P < .001, 95% CI: 1.62-2.36) and a 64% increased CVD mortality risk (OR = 1.64, P = .007, 95% CI: 1.15-2.34). Subgroup analyses revealed stronger associations in males and diabetic subgroups. The highest risks were observed for myocardial infarction (OR = 4.07, P = .015, 95% CI: 1.31-12.63) and atrial fibrillation (OR = 2.93, P < .001, 95% CI: 2.23-3.86). Significant interactions were detected by sex (P = .032) and cardiovascular outcome type (P = .001), but not by age, region, or study design.

Conclusion: Sarcopenic obesity is a high-risk phenotype associated with significantly elevated CVD incidence and mortality, with effect modification by sex and outcome type. These findings highlight the need for standardized diagnostic criteria and targeted interventions to mitigate cardiovascular risk in this growing population.