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): 18.0-60.0,  Sickle Cell Anemia Pulmonary Hypertension FOR RIGHT HEART AND ECHO: 1. Either gender, aged greater than 18 years 2. Diagnosis of sickle cell disease (electrophoretic documentation of SS, SC, or S Beta-thalassemia genotype is required) 3. Hematocrit greater than 18 % (with an absolute reticulocyte count greater than 100,000/ml)  FOR RIGHT HEART AND ECHO: 1. Pregnancy or lactation 2. Known or suspected coronary artery disease 3. Hematocrit less than 18 %: will not be eligible for the study; may return for evaluation at a later date 4. Significant renal insufficiency (patient on hemodialysis or estimated creatinine clearance less than 30% of normal 5. Cerebrovascular accident within the last six weeks 6. New diagnosis of pulmonary embolism within the last three months 7. History of retinal detachment 8. Patients with PAH known to be secondary to other causes, such as systemic lupus erythematosus, other collagen vascular diseases, valvular heart disease, congenital heart disease 9. Poor echo windows 10. Any other condition that would prevent participation in the study (for example HIV infection) FOR NON-INVASIVE 1. Either gender, aged greater than 18 years 2. Diagnosis of sickle cell disease (electrophoretic documentation of SS, SC, or S Beta-thalassemia genotype is required) FOR NON-INVASIVE 1. Pregnancy or lactation 2. Known or suspected coronary artery disease 3. Significant renal insufficiency (patient on hemodialysis or estimated creatinine clearance less than 30%of normal 4. Cerebrovascular accident within the last six weeks 5. New diagnosis of pulmonary embolism within the last three months 6. History of retinal detachment 7. Patients with PAH known to be secondary to other causes, such as systemic lupus erythematosus, other collagen vascular diseases, valvular heart disease, congenital heart disease 8. Patients who are intolerant of MRI will not undergo cardiac MRI 9. Any other condition that would prevent participation in the study (for example HIV infection)