BACKGROUND: Yoga, a popular mind-body practice, may produce changes in cardiovascular disease (CVD) and metabolic syndrome risk factors. DESIGN: This was a systematic review and random-effects meta-analysis of randomized controlled trials (RCTs). METHODS: Electronic searches of MEDLINE, EMBASE, CINAHL, PsycINFO, and The Cochrane Central Register of Controlled Trials were performed for systematic reviews and RCTs through December 2013. Studies were included if they were English, peer-reviewed, focused on asana-based yoga in adults, and reported relevant outcomes. Two reviewers independently selected articles and assessed quality using Cochrane's Risk of Bias tool. RESULTS: Out of 1404 records, 37 RCTs were included in the systematic review and 32 in the meta-analysis. Compared to non-exercise controls, yoga showed significant improvement for body mass index (-0.77 kg/m(2) (95% confidence interval -1.09 to -0.44)), systolic blood pressure (-5.21 mmHg (-8.01 to -2.42)), low-density lipoprotein cholesterol (-12.14 mg/dl (-21.80 to -2.48)), and high-density lipoprotein cholesterol (3.20 mg/dl (1.86 to 4.54)). Significant changes were seen in body weight (-2.32 kg (-4.33 to -0.37)), diastolic blood pressure (-4.98 mmHg (-7.17 to -2.80)), total cholesterol (-18.48 mg/dl (-29.16 to -7.80)), triglycerides (-25.89 mg/dl (-36.19 to -15.60), and heart rate (-5.27 beats/min (-9.55 to -1.00)), but not fasting blood glucose (-5.91 mg/dl (-16.32 to 4.50)) nor glycosylated hemoglobin (-0.06% Hb (-0.24 to 0.11)). No significant difference was found between yoga and exercise. One study found an impact on smoking abstinence. CONCLUSIONS: There is promising evidence of yoga on improving cardio-metabolic health. Findings are limited by small trial sample sizes, heterogeneity, and moderate quality of RCTs.