Peripheral arterial disease (PAD) is under diagnosed and early diagnosis decreases consequences. We screened unrecognized PAD focusing on arterial co-morbidities. In the 3412 subjects, screened from 10 general practices in the city of Catania (Sicily, Italy), ankle brachial index (ABI) measurements were performed. An ABI < or =0.9 was considered as valid in diagnosing PAD. ABI value < or =0.9 was found in 2.3%, and a significant rate of carotid stenosis was also found Echocardiographic markers left ventricular diameter (LVD) >55 mm, interventricular septum (IVS) >11 mm, left ventricular diastolic volume (LVDV) was found > 100 ml), and ejection fraction (EF) was <50% were found with high frequency in those with ABI < or =0.9. Unrecognized PAD is lower compared with other findings but our prevalence resulted higher than other prevalence previously found by other study performed in Italy. Unrecognized PAD shows significant arterial co-morbidities and the ABI is a useful method to screen asymptomatic PAD.