My Plaque Protocol, and Why I Started a PCSK9 Inhibitor | Simon Hill, MSc

Simon Hill (0:00)

A few weeks ago, I shared my own heart scans, and the amount of regression was dramatic. In 16 and a half months, the plaque in my arteries had dropped by 48%.

And the top comment on this video, how did you do this? And underneath that, person after person, asking the same thing.

One person said the whole episode felt like a bait and switch, that they were never going to find out how to actually reduce plaque. Fair enough. That episode, though, was about my results. This one today is how I got them, and whether that 48% was even real. Because here's the part that might seem strange. Despite that number, I've started a prescription medication to lower my blood lipids. In this episode, I'll tell you exactly which one and why. Quick housekeeping before we get into things. This, of course, is not medical advice. It's one person's process, and your numbers belong with your doctor. If you're new here, I'm Simon Hill, physiotherapist by training, Masters in Nutrition Science from Deakin University in Melbourne, and I've interviewed hundreds of researchers and clinicians on this show since 2018

I have a particular interest in cardiovascular disease and track this disease in my own arteries, which is what today's episode is all about.

I'll go as far as saying, I don't think anyone else on the internet has had their coronary arteries analyzed this many ways and then been silly enough to publish all of it. Some might even say that this is a world's first. Take that for what it's worth, of course, it's hardly a competitive field. So a quick recap in case you missed the last episode on this topic. I've had serial coronary CT angiograms or CCTAs.

These scans don't just tell you whether you have blockage, they allow you to quantify how much plaque is in your arteries and what type it is. So instead of being told that you have mild, moderate or severe soft plaque, I got reports breaking it down. Soft plaque, calcified plaque, total volume, all in cubic millimetres. And just so we're clear, this isn't the plaque your dentist talks about. Different plaque, different body part. Though it would be pretty cool if we could floss our arteries. The first scan I had was in December 2024 at age 38 And then a follow up scan 16 and a half months later in April 2026 at 39 I've since turned 40 That's a whole nother story, but happy birthday to me. Same imaging centre both times, same scanner, same protocol. At the Lundquist Institute in Los Angeles, under the guidance of Dr Matthew Budoff, one of the world's experts on this type of imaging. Those scans, the baseline and the follow up scan, were then analysed by three different software platforms. On one of them, HeartFlow, my total plaque volume had dropped by about 48%.

That's the number that ended up in the title of this episode. That's the number that people are asking about. But I want you to hold on to one detail. That 48% came from one of the three platforms that read my scans. Which number I actually trust and why is something that I'll come back to later. Thinking about the results from the three providers changed how I'm treating this. And also raised some rather interesting questions. Before we get to what I did between these two scans, I want to answer a different question from the comment section, because I think it's actually the more interesting one. And it speaks to the origins and the development of atherosclerosis, which is a fancy name for plaque building up in the artery wall. Someone wrote half jokingly, how did he get plaque in the first place if all he eats is vegetables? Just to be clear on the record, I do eat more than just vegetables. But I understand the question. If the evidence supports plant rich diets for lowering cardiovascular risk, how did I have any plaque at all? There are three paths to this answer. The first is that I have not always eaten this way. For the first 30 years of my life, I ate a fairly standard Australian omnivorous diet. Beef, lamb, we love lamb chops in Australia, veal, chicken, milk, butter, etc.

Based on the blood tests I have from my 20s, my LDL cholesterol through that period was sitting around 125 mg per deciliter. It wasn't until I was 30 when I shifted to a plant-based dietary pattern, swapping the meat for foods like tofu and tempeh, beans, etc. Swapping butter for olive oil. When I did that, my LDL came down into the 70s. This is the part that I really want you to hear. It might just be the most useful thing in this entire episode.