Background: Cardiovascular disease (CVD) is the most prevalent comorbidity among breast cancer survivors. In older breast cancer survivors, the risk of dying from CVD is similar to the risk of dying from breast cancer. In addition to pre-existing CVD, it has been suggested that breast cancer survivorship may be associated with increased risk of incident CVD due to direct and indirect effects of cancer treatments and shared risk factors between the diseases. The aim of this systematic review was to investigate the risk of CVD in breast cancer survivors, compared to the general population, in terms of both incidence and mortality. Methods: Relevant articles were identified by structured searches in Embase, Pubmed, CINAHL, and Web of Sciences up until January 22, 2016. Eligible studies were those reporting on CVD incidence and/or CVD mortality in women diagnosed with invasive breast cancer compared to a matched general population sample. Meta-analysis was performed by calculating a meta-rate ratio (mRR) for comparison of relative mortality and overall incidence of CVD using random-effects models. Meta-analysis of specific CVDs was conducted where possible. Results: Of 2,637 articles identified, 21 met the eligibility criteria. Compared to the general population, breast cancer survivors experienced significantly higher risk for overall CVD incidence (13 studies; mRR = 1.20 [95% CI: 1.10, 1.31]) but slightly lower risk of CVD mortality (6 studies; mRR = 0.94 [95% CI: 0.87, 1.03]). When specific CVDs were examined separately, stroke/venous thromboembolism was the only CVD category with significantly increased incidence (6 studies; mRR = 1.24 [95% CI: 1.02, 1.45]). Conclusions: Breast cancer survivors may be more likely to develop CVD but are less likely to die from CVD, compared with age-matched general population. Identifying breast cancer survivors at high risk of CVD incidence is important to inform follow-up care guidelines around screening and prevention strategies to reduce this additional burden on survivors and the health care system.