Context Abdominal aortic calcification (AAC) is a common finding in patients with atherosclerosis. Objective The aim of this study was to demonstrate the incremental value of AAC in predicting long term cardiovascular (CV) outcome by conducting a meta-analysis of observational studies. Data sources MEDLINE and Cochrane databases. Study selection Longitudinal studies with at least 2 years of follow-up, reporting the influence of AAC on CV outcome of general population patients. Data extraction Four separate end points-coronary events, cerebrovascular events, all CV events and CV related death-were tested for their relationship with AAC at baseline, using weighted random effects meta-analysis. Heterogeneity was calculated using Q and I-2 statistic tests. Publication bias was assessed by funnel plot symmetry and trim and fill methods. The importance of calcium quantification was also explored (sensitivity analysis). Results 10 studies were included. An increased relative risk (RR) was found for all end points: for coronary events (five studies, n = 11250) 1.81 (95% CI 1.54 to 2.14); for cerebrovascular events (four studies, n = 9736) 1.37 (1.22 to 3.54); for all CV events (four studies, n = 4960) 1.64 (1.24 to 2.17); and for CV death (three studies, n = 4986) 1.72 (1.03 to 2.86). Analysis of studies presenting results in categories (no/minimal, moderate and severe calcification) revealed a stepwise increase Conclusion Existing data suggest that AAC is a strong predictor of CV related events or death in the general population. The predictive impact is greater in more calcified aortas. The generalisability of the meta-analysis is limited by heterogeneity in the coronary events, all CV events and CV death end points.