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): 50.0-99.0,  Atherosclerosis Hypercholesterolemia A. Men and Women greater than or equal to 55 years of age B. Candidates for lipid lowering therapy under NCEP ATP III guidelines without contraindication to statin therapy C. Willing to modify therapy to enroll in the study D. Willing to travel to the NIH for follow-up visits. E. Able to understand and sign informed consent F. Lab parameters eGFR > 45 mL/min/m2 For age >60 test GFR within 1 week prior to contrast; For age less than or equal to 60 test within 4 weeks FOR THE PET Participants who are not participating in the CT Reproducibility study are eligible. FOR THE Patients will be selected who had a one RR interval initial CT scan with less that 10.5 mSv estimated radiation dosage and who will not be participating in the PET Substudy  A. Ineligibility for MR imaging due to Previous pacemaker implantation Automatic implantable cardioverter-defibrillator (AICD) Metal implants or other ferromagnetic devices, or Foreign material B. Claustrophobia C. Contra-indication or allergy to statin medications. D. Current statin therapy at or above the maximum dosage permitted per study protocol. E. Use of fibrates, ezetimibe, niacin, or bile acid binding agents within 6 months of screening visit. F. Pregnancy and nursing. G. Liver failure defined clinically and by laboratory data. H. Mental, neurologic or social condition preventing understanding of the rationale, procedures, risks and potential benefits associated with the trial. I. Any other conditions that precludes safety for MRI and/or CT imaging per the researcher s evaluation. FOR FOR MAY STILL ALL OTHER STUDY (Inclusive of the above ): 1. Allergy to gadolinium for scans using contrast; will be eligible for non-contrast scans. 2. Acute renal failure, renal transplant, dialysis and renal failure (eGFR < 45 mL/min/m2 and/or clinically diagnosed). 3. Individuals with a history of liver transplant or severe liver disease.<TAB> 4. Individuals with hemoglobinopathies or severe asthma. FOR FOR MAY STILL ALL OTHER SUDY Prior hypersensitivity reaction to iodinated contrast injection, renal dysfunction (defined as eGFR < 45 mL/min/ m2) or a current clinical diagnosis of renal failure FOR THE PET Patients who are unable or unwilling to comply with the physical activity restrictions or fast for 12 hours prior to FDG PET scanning will be excluded. Due to the need for dietary manipulation and the maintenance of strict glycemic control we will diabetic patients from our initial study sample. Blood glucose measurements before injection must be within normal limits, less than 200 mg/dL (11 mmol/L) FOR THE Patients who did not have a one RR interval initial CT scan. Patients who will participate in the PET Substudy