In our continuing search to find systemically bioavailable ACAT (acyl-CoA:cholesterol O-acyltransferase) inhibitors with more potent antiatherosclerotic effect than N-[2-(dimethylamino)-6-[3-(5-methyl-4-phenyl-1H-imidazol-1-yl)propoxy] phenyl]-N'-pentylurea (3), a series of phenylureas linked to 4-phenylimidazole were synthesized and evaluated for in vitro inhibitory activity toward both aortic and intestinal ACATs, and for in vivo hypocholesterolemic activity. The structure-activity relationships (SARs) were studied by strategic modification of five regions in the molecule of 3, i.e., by introducing functional groups or exchanging carbon atoms for heteroatoms. The SAR studies allowed us to select optimum substituents in the five regions, as follows. (1) Dimethylamino was convertible into nitro, methyl, ethyl, propyl, isopropyl, and chloro. On the basis of preliminary pharmacokinetic studies, the methyl group in the ortho-position of the phenylurea was selected. (2) Butyl, pentyl, isopentyl, and neopentyl were better substituents in the urea moiety. (3) Propoxy was the optimal moiety in the bridging portion. (4) Proton, methyl, ethyl, isopropyl, hydroxymethyl, and chloro were better substituents at the 5-position of the imidazole moiety. (5) An unsubstituted phenyl ring was selected as the phenyl group of phenylimidazole. The subsequent comparison studies of compounds containing various combinations of the optimum substituents in each region resulted in the selection of two compounds (67, 68) for further pharmacological and toxicological testing. These compounds were orally bioavailable, and possessed potent in vitro aortic ACAT inhibitory activity (IC50 = 0.16 and 0.012 microM, respectively) and in vivo cholesterol lowering effect (46% and 52% at 1 mg/kg po, respectively). In particular, 68 was 10-fold more potent in the in vitro aortic ACAT assay and 5-fold more potent with respect to hypocholesterolemic activity in vivo than 3.