Introduction: Peripheral arterial disease(PAD) and abdominal aortic aneurysm(AAA) are two important underdiagnosed vascular pathologies. As they share common risk factors with coronary arterial disease, we conducted a study to look at their prevalence among patients with acute coronary syndrome(ACS). Materials and Methods: Patients with ACS admitted to Queen Elizabeth Hospital, Malaysia, from February 2009 till August 2009 were screened prospectively for PVD and AAA. Patients’ data and clinical findings were gathered and analyzed. Measurements of ankle brachial index (ABI) and abdominal aortic diameter were performed by a single assessor. PAD was defined as ABI ≤ 0.9 or diabetic patients with signs and symptoms of PAD and absence of pedal pulses. AAA was defined as abdominal aortic diameter ≥ 3cm. Results: 102 patients were recruited with mean age of 59.5 years old. Male: female ratio was 6:1. 40.2% of patients had NSTEMI; 45.1%, STEMI and 14.7%, unstable angina. Risk factors profile is as follows: hypertension- 68.6%, smoking-56.9%, hypercholesterolemia- 52.9%, diabetes mellitus-35.3% and history of stroke- 5.9%. Median ABI was 1.1 with lowest reading of 0.4. Mean abdominal aortic size was 2.0cm with largest diameter of 3.3cm. PAD was present in 24.5% of patients and AAA in 2.0%. 68.0% of patients with PAD were asymptomatic. Smoking and age more than 60 years were independent predictors for PAD among ACS patients. Conclusions: PAD is strongly correlated with CAD with old age and smoker as independent predictors. However, association between AAA and ACS could not be established.