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

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A few weeks ago I published my own coronary CT angiogram results, and the top comment underneath was the same question asked over and over: how did you do it? One person said the episode felt like a bait and switch. Fair enough. That episode was about the results. This one is about the protocol behind them, and about whether the headline number was ever real in the first place.

Here is the tension. A single platform, HeartFlow, read my two scans and reported a 48% drop in total plaque volume. Two other platforms read the same images from the same scanner on the same days and disagreed, one finding almost no change and one finding a 20% increase. I could have shown you only the flattering result and built something to sell off the back of it. Instead I am showing you all three, explaining which one I anchor to and why, and telling you about the prescription medication I have started despite that 48% headline. The interesting story here is not the number. It is what the disagreement between these tools tells us about how much confidence any of us should place in short-interval plaque tracking.

What We Cover:

  • How I ended up with plaque at 38 despite a decade of eating well, and why cumulative exposure matters more than today’s cholesterol reading
  • The exact nutrition, training, sleep, and supplement protocol I ran between the two scans, including what I deliberately did not take
  • Three platforms, one heart: 11.5, 60, and 74 cubic millimetres of plaque from the same images
  • Why one company says there is a grain of rice in my arteries and another says six
  • Which analysis Dr Matthew Budoff trusts, and the published warning about AI overestimation sitting behind his answer
  • The 25-point percentile swing that comes purely from whose reference population you stand next to
  • Why I started a PCSK9 inhibitor at an ApoB of 70 to 80, and how I chose between Repatha and a statin
  • The minimum interval the American College of Cardiology recommends between serial scans, and why mine was too short

If there is one thing to take from this, it is that all three analyses agreed on what actually matters: my plaque burden is low and it is not progressing rapidly. The headline was never the point. Be sceptical of dramatic short-interval scan results, including mine.

  • The Question Everyone Asked (00:00)
  • Housekeeping, and Why I Track This (00:55)
  • How Serial CT Angiograms Work (01:45)
  • Two Scans, Three Analyses (02:25)
  • How Did I Get Plaque in the First Place? (03:55)
  • Cumulative Exposure and Area Under the Curve (04:40)
  • What REACT Found in Men in Their Thirties (05:50)
  • Why ApoB Is Not the Whole Story (07:10)
  • Genetics, and How Much of Risk Is Polygenic (08:20)
  • The Counterfactual I Can Never Test (10:25)
  • GLAGOV, and How Low Is Low Enough (11:05)
  • My Nutrition Protocol (12:25)
  • You Do Not Have to Eat Like Me (14:20)
  • Training, Padel, and VO2 Max (15:30)
  • Sleep, and the Only Lever I Have (17:00)
  • The Supplements I Was Deliberately Not Taking (19:10)
  • Not Taking Life Too Seriously (20:35)
  • Three Platforms, Three Different Answers (22:10)
  • A Grain of Rice, or Six (24:20)
  • Which Direction Was It Going? (25:20)
  • Why the Platforms Disagree (27:10)
  • Which Number Dr Matthew Budoff Trusts (28:50)
  • The Miami Heart Study and AI Overestimation (29:40)
  • Where I Actually Sit for My Age (31:35)
  • The Percentile That Moves 25 Points (33:20)
  • Plaque Composition, and Signs of Hardening (35:40)
  • The Medication I Started, and Why (37:20)
  • Why One Drug Is Enough (40:55)
  • PCSK9 Inhibitor Versus Statin (41:55)
  • Statin Side Effects, Honestly (43:15)
  • Lurochol, Repatha, and Outcome Data (44:35)
  • Aged Garlic Extract (45:25)
  • Three Takeaways (47:15)
  • Be Sceptical of Short-Interval Scans (48:50)

Referenced Episodes

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