The epidemiology of peripheral arterial disease (PAD) has been studied almost exclusively in northern European and northern American populations. We report the first survey in Italy to describe the prevalence of symptomatic PAD and clinical correlates. From the lists of seven general practitioners, all subjects aged 40-80 years (n = 4352) received a Rose Questionnaire (RQ). In those reporting pain in the leg while walking, which did not disappear while continuing to walk (n = 760), Doppler examination was performed. PAD was defined by ankle/brachial < or = 0.90, or reduced flow velocity. The prevalence of symptomatic PAD was 1.6% (2.4% in men, 0.9% in women). For each PAD patient, three controls matched for sex and age were randomly selected. At the multivariate analysis, smoking, diabetes and hypertension were significantly associated with PAD. A coexistent cardiovascular disease was found in 34% of patients and 11% of controls (P < 0.001). Only PAD was shown to be independently associated with a previous cardiovascular event. Although symptomatic, 45% of the patients were unaware of their condition. In conclusion, prevalence and cardiovascular comorbidity of symptomatic PAD in Italy seem to be lower than in other western countries. The finding that PAD was unrecognised in about 50% of affected individuals implies that a large proportion of PAD population is not given preventive therapy, so remaining at high cardiovascular risk. Thus, there is need to alert general practitioners to this topic.