Association between knee cartilage degradation and cardiac remodeling: A cross-sectional analysis in a community-based cohort

Objectives: Osteoarthritis, a leading cause of disability, has been epidemiologically linked to cardiovascular disease (CVD), yet the relationship between structural cartilage degeneration and cardiac remodeling remains poorly characterized. This cross-sectional study investigates whether knee cartilage degradation, quantified via ultrasonography, correlates with echocardiographic markers of subclinical cardiovascular dysfunction. Methods: Middle-aged and elderly people aged 35 to 75 years who met the inclusion criteria were enrolled. Knee cartilage degradation was scored (0–3 per side) using ultrasound, with total scores categorized as normal (0–3, n = 1,041) or degraded (≥4, n = 430). Cardiac structure and function parameters, including left ventricular ejection fraction, left atrial volume index (LAVI), left ventricular mass index, and diastolic function (mitral valve e ’ and E / e ’ ratio), were measured by echocardiography. Group comparison, logistic regression, subgroup and sensitivity analyses, and XGBoost machine learning were used to assess associations and feature importance. Results: Participants with degraded cartilage were older (median age 64 vs. 58 years, p < 0.001) and had a lower male proportion (31% vs. 45%, p < 0.001). The degraded group exhibited a significantly higher median LAVI (29 vs. 27 mL/m², p < 0.001). Subgroup and sensitivity analyses confirmed that the association with LAVI was robust. XGBoost analysis identified cartilage degradation as an important contributor to LAVI (standardized gain value 4.89%, ranking 10 th among 24 variables). Conclusions: Knee cartilage degeneration is associated with left atrial enlargement. These findings underscore the potential role of osteoarthritis-related structural joint damage in subclinical cardiac remodeling, offering a foundation for future exploration of comprehensive care strategies.