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To conduct a systematic review of the literature evaluating tai chi exercise as an intervention for patients with cardiovascular disease (CVD) or with CVD risk factors (CVDRF).We searched (1) MEDLINE, CAB Alt HealthWatch, BIOSIS previews, Science Citation Index, EMBASE, and Social Science Citation Index from inception through October 2007; (2) Chinese Medical Database, China Hospital Knowledge, China National Knowledge Infrastructure, and China Traditional Chinese Medicine Database from inception through June 2005; and (3) the medical libraries of Beijing and Nanjing Universities. Clinical studies published in English and Chinese including participants with established CVD or CVDRF were included. Data were extracted in a standardized manner; 2 independent investigators assessed methodological quality, including the Jadad score for randomized controlled trials (RCTs).Twenty-nine studies met inclusion criteria: 9 RCTs, 14 nonrandomized studies, and 6 observational trials. Three studies examined subjects with coronary heart disease, 5 in subjects with heart failure, and 10 in heterogeneous populations that included those with CVD. Eleven studies examined subjects with CVDRF (hypertension, dyslipidemia, impaired glucose metabolism). Study duration ranged from 8 weeks to 3 years. Most studies included fewer than 100 subjects (range, 5–207). Six of 9 RCTs were of adequate quality (Jadad ≥ 3). Most studies reported improvements with tai chi, including blood pressure reductions and increases in exercise capacity. No adverse effects were reported.Preliminary evidence suggests that tai chi exercise may be a beneficial adjunctive therapy for some patients with CVD and CVDRF. Further research is needed.