Twelve studies comprising 5,011 NMOSD patients and 13,466 controls were included (mean age 45.3±15.4 years; 71.8% female). Compared to controls, NMOSD patients had higher prevalences of hypertension (26.7% vs. 14.8%; pooled odds ratio [pOR] 1.34; 95%CI 1.05-1.70), type 2 diabetes mellitus (T2DM: 14.0% vs. 6.1%; pOR 1.76; 95%CI 1.39-2.23), Stroke (11.4% vs. 1.3%; pOR 5.58; 95%CI 1.35-23.08), coronary artery disease (CAD: 3.1% vs. 2.2%; pOR 1.81; 95%CI 1.26-2.58), and heart failure (HF: 3.4% vs. 0.8%; pOR 3.72; 95%CI 1.88-7.39), while dyslipidemia (10.6% VS 11.8%) was not significantly different. Regarding subgroup analysis of NMOSD vs. non-demyelinating controls, the prevalences of T2DM (15.1% vs. 6.9%), stroke (11.6% vs. 1.2%), CAD (3.1% vs. 2.2%), and HF (3.3% vs. 0.8%) were significantly higher, while DLP (14.3% vs. 24%) was lower in NMOSD. The prevalence of T2DM (11.2% vs. 5.6%) was higher in NMOSD than in MS, but not significantly different compared to other demyelinating controls. Hypertension and dyslipidemia prevalences were not statistically different between NMOSD and MS/other demyelinating controls. Insufficient data precluded a pooled analysis of stroke, CAD, and HF in MS and other demyelinating controls.