Background: recent cohort studies have evaluated the association between six previously identified high-risk ceramides [i.e., Cer(d18:1/16:0), Cer(d18:1/18:0), Cer(d18:1/20:0), Cer(d18:1/22:0), Cer(d18:1/24:0) and Cer(d18:1/24:1)] and risk of major adverse cardiovascular events in adults. The objective of this meta-analysis was to investigate the magnitude of such associations. Methods: we searched publication databases using appropriate keywords to identify cohort studies (published up to July 30, 2019), in which association between six previously identified high-risk ceramides and major adverse cardiovascular events was reported. Data from eligible studies were extracted and meta-analysis was performed using random-effects modeling. Results: nine cohort studies with aggregate data on 33,553 individuals (3,589 new cases of cardiovascular events) were included. Higher plasma levels of Cer (d18:1/16:0) (random effects hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.14-1.36, I2=88%), Cer (d18:1/18:0) (random effects HR 1.17, 95% CI 1.09-1.25, I2=68%), Cer(d18:1/20:0) (random effects HR 1.07, 95% CI 1.00-1.16, I2=0%), and Cer (d18:1/24:1) (random effects HR 1.17, 95% CI 1.09-1.26, I2=82%) were associated with major adverse cardiovascular events. Conversely, no association with plasma levels of Cer (d18:1/22:0) (random effects HR 1.08, 95% CI 0.96-1.26, I2=77%) and Cer (d18:1/24:0) (random effects HR 1.02, 95% CI 0.97-1.07, I2=37%) were found. Subgroup analyses did not substantially modify these findings. No publication bias was observed Conclusions: higher plasma levels of Cer (d18:1/16:0), Cer (d18:1/18:0), Cer (d18:1/20:0), and Cer (d18:1/24:1) were associated with major adverse cardiovascular events, whereas plasma levels of Cer (d18:1/22:0) and Cer (d18:1/24:0) were not. Additional research is needed to elucidate the different role of various ceramides on multiple pathways involved in cardiovascular disease.