Objectives: We sought to examine the association between mitral annular calcification (MAC) and/or aortic valve sclerosis (AVS) and systemic endothelial manifestations of the atherosclerotic process.Background: Clinical and experimental studies suggest that MAC and/or AVS are manifestations of the atherosclerotic process. Systemic endothelial dysfunction is an early sign of the atherosclerotic process and can be assessed by ultrasonography of the brachial artery.Methods: A total of 75 in-hospital patients (47 men; mean age 62±8 SD) referred to the echocardiography laboratory underwent: 1) trans-thoracic echocardiography, with specific assessment of MAC (included an intense echo-producing structure located at the junction of the atrioventricular groove and posterior mitral valve leaflet on the parasternal long-axis, apical four-chamber, or parasternal short-axis view) and AVS (thickened valve leaflets with a trans-aortic flow velocity :2.5 m/s); 2) an endothelial function study, with assessment of endothelium-dependent, post-ischemic, flow-mediated dilation (FMD);3) carotid artery echo-Doppler to asses carotid intima media thickness.Results: Mitral annular calcification was present in 14 patients (group I) , Aortic valve sclerosis was present in 27 (group II) , both MAC and AVS were present in 19 (group III) and 15 patients as control group. The four groups showed non-significant difference as regard risk factor of atherosclerosis , echocardiographic findings and endothelial dysfunction. Patients with AVS were more likely to have increased IMT in both common carotid arteries when compared with patients without AVS with p-value = 0.001. Patients with both MAC and AVS were more likely to have increased IMT in both common carotid arteries when compared with patients without MAC and AVS with p-value = 0.031. Conclusions: MAC and AVS are associated with increased common carotid artery intima media thickness. MAC and or AVS can be used as a-non invasive tool to detect early atherosclerosis.AVS is associated with increased common carotid artery intima media thickness , hence it is considered as a marker of aortopathy.