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): 18.0-999.0,  Hyperlipidemia Hypercholesterolemia Cardiovascular Disease Diabetes Chronic Kidney Disease (CKD) Hypertension Smoking Myocardial Infarction (MI) Unstable Angina Angina Coronary Artery Disease (CAD) Stroke Transient Ischemic Attack (TIA) Carotid Stenosis Peripheral Arterial Disease Atherosclerosis Claudication Prior evidence of clinical atherosclerotic cardiovascular disease (ASCVD) which can any of the following Hospitalization for acute myocardial infarction or unstable angina Coronary revascularization or chronic coronary artery disease with or without angina Other arterial (carotid, abdominal, renal or lower extremity) revascularization (e.g., surgical bypass, percutaneous intervention, arterial vascular reconstruction, abdominal aortic aneurysm repair, excluding dialysis fistulas or arteriovenous grafts) Ischemic stroke or transient ischemic attack (TIA) Imaging evidence of > 70% diameter stenosis in any carotid artery or clinical documentation of severe carotid stenosis Peripheral arterial disease secondary to atherosclerosis (e.g., aortic aneurysm, ankle brachial index <0.9, imaging evidence of >50% diameter stenosis in any peripheral artery, or claudication) 2. Currently on statin therapy 3. Low density lipoprotein cholesterol (LDL-C) level ≥ 130 mg/dL within the last 2 years (treated or untreated) 4. Age ≥ 65 years 5. Age ≥ 40 years with at least 1 of the following Diabetes Chronic Kidney Disease (CKD), defined as eGFR <60 ml/min or documented stage III or higher CKD year ASCVD risk ≥ 5% (per the 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk)  Unable or unwilling to provide informed consent, including but not limited to cognitive or language barriers (reading or comprehension) 2. Anticipated life expectancy less than 6 months 3. Participation in any clinical trial involving a medical treatment at the time of enrollment