Objective To systematically evaluate the efficacy of Internet-based cognitive behavioral therapy (ICBT) in patients with cardiovascular disease (CVD). Methods A computerized search was conducted in PubMed, EMbase, CNKI, and Wanfang databases to retrieve studies investigating the effects of ICBT on CVD patients, with the retrieval period extending from database inception to August 2025. After screening studies based on inclusion and exclusion criteria and extracting relevant data, a meta-analysis was performed using RevMan 5.3 software. Results A total of 13 RCTs involving 1 365 CVD patients were included. The meta-analysis results indicated that ICBT significantly improved depressive symptoms [SMD=?0.31, 95%CI(?0.44, ?0.19), P<0.001] and overall mental health status [SMD=0.44, 95%CI (0.23, 0.64), P<0.001] in CVD patients. However, no statistically significant differences between the two groups were observed in anxiety levels [SMD=?0.60, 95%CI (?1.33, 0.13), P=0.10], sleep quality [MD=2.60, 95%CI (?2.02, 7.23), P=0.27], or overall physical health status [MD=1.77, 95%CI (?0.16, 3.71), P=0.07].ConclusionICBT serves as an effective tool for mental health management in CVD patients. However, its efficacy in alleviating anxiety, improving sleep quality, and enhancing physical health remains inconclusive. Future studies should focus on optimizing intervention modules and exploring personalized strategies to improve comprehensive therapeutic outcomes.