Background Sarcopenic obesity, characterized by reduced muscle mass and excessive fat, has not been adequately studied regarding its impact on cardio-cerebrovascular disease (CCVD) and related mortality. Objective This systematic review and meta-analysis aimed to evaluate the relationship between sarcopenic obesity, CCVD risk, and associated mortality. Methods We searched PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, WANFANG DATA, Technology Journal Database, and Chinese Biological Medical Database, considering articles from inception to April 1, 2024. Two researchers independently screened the literature, evaluated study quality, and extracted data. Both fixed- and random-effects models were used to pool the estimates of odds ratios (ORs). Publication and sensitivity bias analyses tested the robustness of associations .Results A total of 28 studies, comprising 575,942 participants, were included. The results demonstrated a significant association between sarcopenic obesity and an increased risk of CCVD (OR: 2.06, 95% CI: 1.70-2.48, I-2 = 71%; p < 0.001). Subgroup analyses further indicated that sarcopenic obesity defined by combined measures of muscle mass, muscle strength, and body mass index was associated with a 9.22-fold increased risk of CCVD, and a 2.10-fold increased risk of cardiovascular disease, but no significant association with the risk of stroke was observed. In contrast, when assessing CCVD mortality, seven studies found no significant overall association (OR: 1.58, 95% CI: 0.99-2.53, I-2 = 92%; p = 0.05). However, in subgroup analyses, significant associations emerged in studies with larger sample sizes (>= 5000 participants; OR: 1.76, 95% CI: 1.37-2.27, p < 0.01) and longer follow-up durations (>= 10 years; OR: 1.54, 95% CI: 1.16-2.04, p < 0.01). Conclusions Sarcopenic obesity is associated with an increased risk of CCVD, and its long-term impact on CCVD mortality may be more evident in studies with larger sample sizes and extended follow-up periods. These findings underscore the need for well-designed prospective studies employing standardized diagnostic criteria and adequate follow-up to confirm the observed associations and clarify their clinical significance.