How Your Knee Pain May Signal Cardiovascular Risk
Imagine this: A 62-year-old woman visits her orthopedic specialist for persistent knee pain that worsens with each step. After examination, she receives a diagnosis of knee osteoarthritis—the "wear-and-tear" arthritis that affects millions worldwide. What she and her doctor might not immediately consider is that this joint condition could signal something far more serious: an increased risk for cardiovascular disease.
For decades, medicine has treated joint degeneration and heart conditions as separate domains—one falling under orthopedics and rheumatology, the other under cardiology. But a growing body of scientific evidence reveals an astonishing connection between these seemingly unrelated conditions. This article explores the hidden link between knee osteoarthritis and cardiovascular disease, a connection that could transform how we prevent, diagnose, and treat both conditions.
44%
Increased CVD hazard in women with OA 3
24%
Increased CVD hazard in men with OA 3
29%
Increased stroke risk in OA patients
The connection between knee OA and cardiovascular disease isn't purely coincidental—they share several common risk factors:
Systemic inflammation creates a common biological pathway for both conditions 1 .
Pain from OA often leads to reduced activity, worsening cardiovascular health 3 .
However, shared risk factors only tell part of the story. Emerging evidence suggests deeper biological connections between these conditions.
Traditional understanding of osteoarthritis framed it primarily as a "wear-and-tear" condition—the gradual breakdown of joint cartilage from mechanical stress over time. While mechanical factors certainly contribute, this perspective is now considered incomplete.
Contemporary research reveals that osteoarthritis involves active biological processes, including inflammation, metabolic abnormalities, and immune system involvement 2 . This broader understanding helps explain why osteoarthritis connects to systemic conditions like cardiovascular disease.
Endothelin-1 (ET-1) contributes to both cartilage degradation and atherosclerotic plaque development 1 .
Adipokines from fat tissue are implicated in both vascular remodeling and joint degeneration 1 .
IL-1β, TNF-α trigger inflammatory cascade
MMPs break down cartilage matrix
Reactive oxygen species promote chondrocyte apoptosis
Inflammation damages blood vessel lining
Lipids accumulate in artery walls
Plaque rupture leads to heart attack or stroke
To understand how researchers uncovered the connection between osteoarthritis and cardiovascular disease, let's examine a crucial large-scale study that provided compelling evidence for this link.
1,838,434 adult residents of Denmark, including 290,781 people with knee or hip osteoarthritis and 1,547,653 matched controls without OA.
Data collected from 2001-2015, with participants followed until cardiovascular disease diagnosis, death, or the end of 2015.
| Group | Hazard Ratio | 95% Confidence Interval |
|---|---|---|
| Women with OA | 1.44 | 1.43-1.46 |
| Men with OA | 1.24 | 1.23-1.26 |
The data revealed that women with osteoarthritis face a substantially greater increased risk of cardiovascular disease compared to men with the same condition—a finding that persisted even after adjusting for age, education, and obesity 3 .
Data from Danish registry study showing increased risk of various cardiovascular conditions in OA patients
"Clinicians who care for patients with osteoarthritis should be aware of cardiovascular disease risk when selecting therapies and consider behavioural approaches to improving health-related physical activity behaviour in this population."
A groundbreaking 2024 study published in Nature Communications challenged conventional thinking by revealing that shared genetic factors may underlie both conditions 6 .
85%
of OA-CVD correlation explained by genetic factors 6
The research analyzed data from 59,970 twins and found that the correlation between osteoarthritis and cardiovascular disease could be explained by shared genetic factors, independent of age and body weight 6 .
This research suggests that the relationship between these conditions isn't merely one causing the other, but rather that they may share common biological origins 6 .
If osteoarthritis increases cardiovascular risk, could interventions that address OA symptoms also protect cardiovascular health? Compelling evidence suggests the answer is yes—particularly regarding physical activity.
| Activity Level | Hazard Ratio for CVD | 95% Confidence Interval |
|---|---|---|
| OA with no exercise | 1.25 | 1.11-1.40 |
| OA with weekly exercise | 1.11 | 0.96-1.28 |
A 2023 Korean study with 201,466 participants showed exercise neutralizes CVD risk in OA patients
Remarkably, the study revealed that people with knee osteoarthritis who exercised at least once a week had no statistically significant increased CVD risk compared to those without OA, whereas inactive OA patients had a 25% higher risk .
Regular physical activity may effectively neutralize the excess cardiovascular risk associated with osteoarthritis, offering a powerful preventive strategy.
Why do women with OA face a substantially higher CVD risk than men?
Identifying specific pathways could lead to targeted treatments.
Would aggressive early treatment of OA impact long-term heart health?
Translating genetic discoveries into clinical practice.
The compelling connection between knee osteoarthritis and cardiovascular disease represents a paradigm shift in how we view both conditions. What was once considered simple comorbidity between unrelated diseases is now understood as a complex relationship with shared risk factors, common biological mechanisms, and possibly even shared genetic origins.
This understanding brings both challenges and opportunities. The challenge lies in overcoming specialized medical silos that separate joint health from cardiovascular care. The opportunity exists to develop integrated treatment approaches that address both conditions simultaneously—potentially improving outcomes and quality of life for millions.
For individuals living with osteoarthritis, these findings underscore the importance of viewing joint health as an integral part of overall wellness. Effective management of osteoarthritis through appropriate exercise, weight management, and medical care may offer the dual benefit of preserving both mobility and cardiovascular function.