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Employees are severely affected by psychological distress, poor cardiometabolic health, and reduced productivity. Meditation has emerged as a potential strategy to enhance overall health. This systematic review synthesised the effectiveness of meditation for improving employees' mental health and cardiometabolic risk (CMR) markers across 132 randomised controlled trials (145 intervention groups and 23,080 participants). Most interventions were Mindfulness and Transcendental Meditation, conducted in the USA, and targeting healthcare professionals and educators. Results showed that meditation significantly improved perceived stress (g = -0.51), distress (g = -0.49), job stress (g = -0.53), anxiety (g = -0.38), depression (g = -0.39), well-being (g = 0.41), resilience (g = 0.38), and sleep (g = -0.33), with most effects sustained within three-month follow-ups. Effects on perceived stress, distress, and well-being were sustained at long-term follow-up. Interventions did not show statistically significant differences in blood pressure, cortisol level, heart rate variability, or inflammatory markers. The findings require cautious interpretation due to moderate-to-substantial heterogeneity, high risk of bias, and limited CMR marker studies. The evidence certainty was moderate for well-being and sleep, and low to very low for the remaining outcomes.