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

Atherosclerosis management requires a nuanced understanding of cumulative exposure and genetic risk rather than relying solely on current cholesterol levels. Despite maintaining a plant-based diet, regular exercise, and optimal sleep, persistent coronary artery plaque necessitates a shift from lifestyle-only management to targeted pharmaceutical intervention. Quantitative coronary CT angiography (CCTA) reveals significant discrepancies between AI-driven analysis platforms, highlighting the importance of using consistent measurement tools and long-term intervals for tracking disease progression. By initiating a PCSK9 inhibitor to target an ApoB level below 40 mg/dL, the goal shifts from merely slowing plaque accumulation to achieving long-term stabilization and potential regression. Ultimately, cardiovascular health is a lifelong endeavor where personalized medical strategies, informed by family history and serial imaging, complement consistent, healthy lifestyle habits to mitigate the risk of future cardiac events.