Carotid intima-media thickness (CIMT) is a measure of the extent of atherosclerosis present in an individual, and increasing CIMT is associated with a higher likelihood of future cardiac events such as heart attacks. A higher ratio of total cholesterol (TC) over high-density lipoprotein cholesterol (HDL-C) is associated with increased CIMT. Statin therapy is generally well-tolerated and has been shown to reduce the risk of future cardiac events in individuals with cardiac risk factors, even in the absence of hypercholesterolemia (TC ≥ 240 mg/dl), and has also been shown to reduce CIMT in high-risk individuals.  However, firefighters without hypercholesterolemia rarely receive statin therapy. The goal of this project was to determine if this treatment prevents progression of CIMT in firefighters and improves other cardiovascular disease risk factors. This was done by conducting a two-year randomized interventional trial of statin therapy in firefighters with high TC/HDL-C. Phoenix area firefighters who had a TC/HDL-C ratio ≥ 5.0 and were not taking statin therapy were eligible for participation and 124 were selected. Then, half of these people were randomly assigned to receive 10 mg of rosuvastatin per day for two years and the other half were followed over this same period as a control group. CIMT and other biomarker measurements were taken at the beginning, 12-month mark, and 24-month mark of this study. This project was part of a FEMA Assistance to Firefighters Grant Program.