A finding from the Cholesterol Lowering Atherosclerosis Study (CLAS), a clinical trial, indicated that common carotid intima-media thickness responded more rapidly and more markedly to LDL-C lowering treatment than angiographic coronary stenosis or carotid roughness. New data from a primate model also showed ultrasound detection of intimal thickening in response to a hypercholesterolemic diet within twelve months. These findings suggest that carotid IMT is a reliable and rapidly responding marker of extent of atherosclerosis. However, less than a third of the observed therapeutic benefit on carotid IMT found in CLAS was explained by change in LDL-C and HDL-C, suggesting that related (or other) factors are more directly linked to atherogenic mechanisms. In addition, a Finnish epidemiologic study found that LDL-C was predicative of rate of progression in carotid IMT only in persons with high serum levels of (pro-oxidant) copper. . These and other data support a model of atherosclerosis in which intracellular accumulation of modified LDL is promoted/retarded by serum pro-oxidants/antioxidants.