Introduction: Although lower extremity arterial disease (LEAD) is the third leading cause of atherosclerotic morbidity, it is still underdiagnosed and undertreated. In most cases, it is discovered in advanced stages. Ankle-brachial index (ABI) is the first-line noninvasive diagnostic method for LEAD. (1-3) The primary goals of our research were: to determine the prevalence of LEAD in the general population and to compare it with the prevalence of two early predictors of endothelial dysfunction - left ventricular diastolic dysfunction (LVDD) and plasma concentrations of asymmetric dimethylarginine (ADMA). Secondary goal was to evaluate the effect of drugs on ADMA concentration.

Patients and Methods: We conducted a cross-sectional study which included 165 subjects from general population aged 40 to 65 years. We used transthoracic echocardiography to assess left ventricular diastolic function (LVDF). For assessment of LEAD we used ABI, and additionaly duplex ultrasound if ABI was ≤ 1.0 or ≥ 1.4. ADMA was determined from venous blood sample using ELISA method. Subjects were divided into 3 groups: the 1st group - with normal left ventricular diastolic function (LVDF), the 2nd group – with LVDD only and the 3rd group – with coexisting LVDD and LEAD.

Results: LEAD was confirmed in 21 (13%) participants, the majority were smokers, had diabetes mellitus, heart failure, coronary artery disease, atrial fibrillation and chronic kidney disease. Even 14 of them (67%) were asymptomatic. Participants with normal LVDF had the highest and those with coexisting LEAD and LVDD the lowest plasma ADMA values. Most antihypertensives, as well as acetylsalicylic acid, MRA, insulin and SGLT2 inhibitors reduced ADMA values, but the most powerful were statins.

Conclusion: We should look for LEAD more often, considering that the vast majority of patients are asymptomatic. Many drugs that we use today to treat dyslipidemia, hypertension, HF and DM improve endothelial function, but statins are the most effective.