Technological advances in arterial wall imaging have provided the opportunity to evaluate the impact of medical therapies on the progression of atherosclerosis in vivo. Arterial imaging has been extensively utilized to determine the impact of high-dose statin therapy. Using multiple imaging modalities in the carotid and coronary territories, rosuvastatin has been demonstrated to have a beneficial impact across the spectrum of cardiovascular risk. The impact of modifying levels of atherogenic lipids, HDL and markers of inflammation will be reviewed.