The known natural history of peripheral artery disease (PAD) is determined by the generalization of atherosclerosis with resulting high cardiovascular and cerebrovascular morbidity and mortality. In the meantime PAD patients are not receiving secondary prevention therapies even though there is enough evidence. It is difficult to diagnose PAD by symptoms alone and furthermore, over 50% PAD patients are asymptomatic. Measurement of the ankle brachial pressure index (ABI) is cost effective and simple means of identifying PAD. Targeted ABI screening and subsequent treatment in primary care practices will save health care costs by reducing cardiovascular and cerebrovascular morbidity and mortality. But we should discuss carefully whether to antiplatelet therapy benefits for asymptomatic individuals with screen-detected PAD are not established.