The impact of knee osteoarthritis on cardiovascular disease mortality: A systematic review and meta-analysis

Objective This study aimed to conduct a systematic review and meta-analysis to evaluate the risk of cardiovascular disease (CVD) mortality in patients with knee osteoarthritis (OA). Design A systematic search of PubMed, Cochrane Library, and Web of Science was conducted through January 23, 2026. Cohort studies reporting risk estimates of CVD mortality in knee OA were included. Pooled hazard ratios (HRs) were calculated using a random-effects model. Subgroup analyses were performed based on knee OA classification (radiographic knee OA only, symptomatic knee OA only, and both radiographic and symptomatic knee OA) and gender. Results Six cohort studies comprising 476,665 patients were included in this meta-analysis. Knee OA was associated with an increased risk of CVD mortality (Pooled HRs: 1.22; 95 % CI: 1.07, 1.39, p = 0.002). However, subgroup analyses showed no significant association based on radiographic knee OA only (Pooled HRs: 1.19; 95 % CI: 0.91, 1.55, p = 0.20), and both radiographic and symptomatic knee OA (Pooled HRs: 1.53; 95 % CI: 0.98, 2.41, p = 0.06). By sex, no significant association was found in males (Pooled HR = 0.97, 95 % CI: 0.83, 1.13, p = 0.68), while females had a significantly increased risk of CVD mortality (Pooled HR = 1.28; 95 % CI: 1.04, 1.59, p = 0.02). Conclusion Knee OA was associated with an increased risk of CVD mortality, with a more pronounced association observed among females. These findings suggest that CVD risk may warrant consideration in patients with knee OA.