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): 18.0-75.0,  Hypercholesterolemia Atherosclerosis Coronary Artery Disease Diagnosis and for Diagnosis: This study was designed for untreated subjects with primary hypercholesterolemia with plasma LDL-C concentrations between >=3.3 mmol/L (130 mg/dL) to <=4.6 mmol/L (180 mg/dL) and triglyceride concentrations of <3.99 mmol/L (350 mg/dL), and coronary heart disease for whom diet and exercise have failed and now require drug therapy Subjects must demonstrate their willingness to participate in the study and comply with its procedures by signing a written informed consent Subjects must be >=18 years and <=75 years of age Subjects must have an LDL-C concentration >=3.3 mmol/L (130 mg/dL) to <=4.6 mmol/L (180 mg/dL) using the Friedewald calculation available at the time of randomization Visit 3 (Baseline Visit) Subjects must have triglyceride concentrations of <3.99 mmol/L (350 mg/dL) at Visit 3 (Baseline Visit) Subjects must have documented coronary heart disease (CHD). For the purposes of this study, CHD will one or more of the following features: documented stable angina (with evidence of ischemia on exercise testing); history of myocardial infarction; history of percutaneous coronary intervention (primarily PTCA with or without stent placement); symptomatic peripheral vascular disease (claudication); documented history of atherothrombotic cerebrovascular disease; and/or documented history of unstable angina or non-Q wave myocardial infarction Subjects must not be currently taking an approved statin. Subjects with a previous history of statin use must have not used a statin for at least 6 months prior to Visit 3 (Baseline Visit) Subjects must have liver transaminases (ALT, AST) <50% above the upper limit of normal, with no active liver disease, and CK <50% above the upper limit of normal at Visit 3 (Baseline Visit) Clinical laboratory tests (CBC, blood chemistries, urinalysis) must be within normal limits or clinically acceptable to the investigator at Visit 3 (Baseline Visit)  Subjects whose body mass index is >=30 kg/sqm at baseline Subjects who have known hypersensitivity to HMG-CoA reductase inhibitors Subjects who consume >14 alcoholic drinks per week Any condition or situation that, in the opinion of the investigator, might pose a risk to the subject or interfere with participation in the study Women who are pregnant or nursing Subjects who have not observed designated washout periods for prohibited medications (eg, potent inhibitors of CYP3A4, prescription or over-the-counter agents know to lower lipid levels, corticosteroids), or have been on a stable regimen of any cardiovascular agent for <6 weeks