Introduction:The goal of 10,000 steps/day is widely promoted. There is limited evidence, however, of the number of steps/day associated with risk of developing cardiovascular disease (CVD).Hypothesis:We hypothesize a dose-response association between higher device-measured steps/day with lower CVD incidence.Methods:The Steps for Health Collaborative conducted a meta-analysis of seven prospective studies with device-measured steps/day and followed participants for CVD events. Participants without CVD at baseline were included. CVD was defined as coronary heart disease, stroke, and/or heart failure. Data were analyzed at the study level. Study-specific associations of quartiles of steps/day with incident CVD was assessed using Cox proportional hazards regression models and summarized using random effects meta-analysis. Models were adjusted for age, race/ethnicity, sex, body mass index, device wear time, and study-specific indicators for education or income, smoking, alcohol intake, blood pressure, dysglycemia, and hyperlipidemia. Study heterogeneity was assessed using I2 statistic.Results:The meta-analysis included 16,906 adults (mean age 62 years; 51% women), with median follow-up of 6.3 years (limits 2.9-10.7 years) and 1370 (8.1%) CVD events. Medians of study-specific steps/day were 1,951 (first quartile, Q1), 3,823 (second quartile, Q2), 5,685 (third quartile, Q3), and 9,487 (fourth quartile, Q4). Compared with Q1, summary hazard ratios for CVD were 0.83 (Q2, 95% confidence interval 0.72-0.95), 0.68 (Q3, 0.58-0.80), and 0.60 (Q4, 0.47-0.78) (Figure). There was low to moderate heterogeneity; I2 values were 0% for Q2, 2% for Q3, and 37% for Q4.Conclusions:Higher steps/day were associated with progressively lower risk of CVD. Monitoring and promoting steps/day can be a simple, easy to interpret metric used for clinician-patient communication and population health to reduce the risk of CVD.