Patient description: A 46-year-old man presents with dizziness and frequent headaches. He has a family history of CAD, but no other cardiovascular risk factors such as smoking, high blood pressure, and diabetes mellitus and is physically active. The patient's LDL-C and HDL-C levels were 545 and 53 mg/dL, respectively. His fasting glucose and triglyceride levels (85 and 158 mg/dL, resp.) were within normal limits. The patient reported no use of lipid-lowering medications. Neck auscultation revealed a systolic murmur 3+/6+ in the neck, radiating to the skull. Ultrasonography of the carotid arteries, revealed severe stenosis in the left internal carotid artery (LICA), as well as moderate stenosis in the right internal carotid artery (RICA) estimated between 40% and 50%. For the LICA, the peak-systolic (PSV) and end-diastolic velocity (EDV) cutoff values were 208.5 cm/s and 54.5 cm/s, respectively; RICA PSV was 91.72 cm/s and RICA EDV was 37.37 cm/s. Plaque was observed in the anterior and posterior walls of the internal carotid artery and common carotid artery, which were characterized as bulky plates extending to the middle third of the internal coronary arteries (ICAs) and as predominantly echogenic and hyperechoic, with less than 50% of the area being echolucent with uneven surfaces.

Clinical trial eligibility criteria: eligible ages (years): 50.0-999.0,  Diabetes Mellitus High Blood Pressure Cardiovascular Diseases Cognitive Impairment Systolic Blood Pressure (SBP) between 130 and 180 mm Hg to 150 mm Hg (if on 0-4 medications) to 160 mm Hg (if on 0-3 medications) to 170 mm Hg (if on 0-2 medications) to 180 mm Hg (if on 0-1 medications) Type 2 diabetes To be considered as having a high cardiovascular risk, including AT LEAST ONE of the following factors: 1. Established cardiovascular disease (CVD), including Coronary artery disease: previous myocardial infarction, previous acute coronary syndrome, previous percutaneous coronary intervention, previous coronary artery bypass graft surgery, or at least 50% stenosis in a main coronary artery associated with typical angina pectoris; or Cerebrovascular disease: previous stroke (except those events caused by intracranial aneurysm or arteriovenous malformation) or previous transient ischemic attack (TIA), stable for at least 2 weeks preceding in the study; or Carotid artery disease: previous carotid endarterectomy, previous percutaneous intervention with carotid stent implantation, or asymptomatic stenosis of at least 50% in a carotid shown by the Doppler ultrasonography; or  Refusal to provide written informed consent Body mass index > 45 kg/m2 Known secondary cause of hypertension Severe renal dysfunction with GFR < 20 mL/min/1.73m2 calculated by the CKD-EPI equation Angina at rest Class IV Canadian Cardiovascular Society (CCS) Acute coronary syndrome in the last six months Symptomatic heart failure Class IV New York Heart Association (NYHA) or ejection fraction < 35% on Doppler echocardiography in the last six months Factors that at the research team´s judgment may limit adherence to the intervention and study protocol, including, but not limited to, the following examples Recent history of alcohol and illicit drug abuse Psychiatric comorbidities (severe depression, schizophrenia, psychosis, etc.)