Abstract Objective: The study aimed to search for the suggested association of hand osteoarthritis (HOA) with the evidence of atherosclerotic vascular disease in population above 45 years old. Patients and methods: This study was carried out at the Department of rheumatology and cardiology, Sohag University Hospital, during 2013-2016. It is a Crosssectional study comprising the following groups: 30 patients with HOA above 45 years old, 30 patients with non-hand osteoarthritis (knee OA) above 45 years old and 30 healthy volunteers as control. The three groups were compared clinically and through ECG, trans thoracic echo TTE and carotid doppler. Coronary angiography was done for selected patients. Follow up and recording of adverse cardiovascular events was carried out for 18-24 months. Results: The mean age of the study group was 56.41 ± 6.494 years. Knee OA patients was older than HOA and control subjects. The three groups were matched as regard sex, smoking and BMI. HOA patients showed the most frequent cardiac manifestations. (26.7%) of HOA patients had ECG findings suggestive of ischemia. TTE examination of the studied population showed that (LVH, SWMA and aortic sclerosis) was more prevalent among patients with hand OA followed by knee OA and least in the control group. There is a positive, weak, non-significant correlation between severity of atherosclerosis and severity of OA. Follow up for adverse cardiovascular events ACE for all groups at 18-24 months interval. 2 patients (6.6%) in hand osteoarthritis group developed stable angina with no admission in CCU but diagnosed on the basics of outpatient clinic, one of them had coronary angiography and revascularization, another patient developed myocardial infarction at 10 months follow up and revascularization at discharge of CCU. One patient (3.3%) in Knee OA group developed stroke with partial recovery. One patient in the control group lost during follow up time.