Background: Osteoarthritis (OA) is the commonest musculoskeletal disease; the relation between knee osteoarthritis, cardiovascular risk factors and metabolic syndrome (Mets) has been previously reported but not yet thoroughly studied. Objectives: to evaluate the relation between cardiovascular risk factors and metabolic syndrome and knee osteoarthritis. Patients and methods: This is a hospital-based cross-sectional study, was done on 200 patients with knee OA at outpatient clinic of physical medicine, Rheumatology, and Rehabilitation Department of Qena University Hospital. Results:  200 patients in this study with mean age (56.7 ±10.3) P value (0.001) , mean body mass index (BMI)(27.5±4.5) P value (0.313)and mean disease duration (10±5.5) P value (0.003). 111 of patients who have abnormal ECHO ((49.1%) of them were diabetic, (85.7%) hypertensive, (58.9%) obese, (58%) hyperlipidemic, (84.8%) of them have full criteria of metabolic syndrome. 119(59.5%) of knee osteoarthritis patients that involved in this study have metabolic syndrome. Conclusion: The findings of this study showed that there is an association between cardiovascular risk factor, metabolic syndrome and knee osteoarthritis and   show their significant role in the development and progression of knee osteoarthritis.