Unrecognised myocardial infarction (MI) is a MI that remains undetected in the acute phase and is associated with an unfavourable prognosis. With this systematic review and meta-analysis, we evaluated the burden of cardiovascular risk factors in individuals with unrecognised MI. We searched general population-based cohort studies diagnosing unrecognised MI by electrocardiogram or myocardial imaging up to 24 November 2023. Pooled mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI) were determined, and random-effects meta-analyses were performed. Fourteen cohort studies were included involving 200,450 individuals (mean age 62.8±9.9 years, 56.0% women), among which 4,322 (2.2%) experienced unrecognised MI (mean age 66.3±8.2 years, 47.8% women) and 4,653 (2.1%) recognised MI (mean age 68.5±7.3 years, 33.8% women). Compared to individuals without MI, those with unrecognised MI had higher body mass index (MD 0.27, 95% CI 0.16-0.39) and systolic blood pressure (MD 4.48, 95% CI 2.81-6.15), and higher prevalence of hypertension (RR 1.27, 95% CI 1.06-1.51) and diabetes mellitus (RR 1.67, 95% CI 1.36-2.06). Furthermore, individuals with unrecognised MI had lower prevalence of hypertension (RR 0.92, 95% CI 0.88-0.97) and diabetes mellitus (RR 0.80, 95% CI 0.70-0.92). Individuals with unrecognised MI are characterised by a substantial burden of metabolic risk factors. Our findings suggest insufficient recognition and management of cardiovascular risk factors among individuals with unrecognised MI.