The Proof with Simon Hill
The Proof with Simon Hill

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

October 5, 2026

AI Summary

5 min read

Simon Hill, host of The Proof, is not a typical podcast subject. He is a 40-year-old with a master’s in nutrition science, a plant-based diet, a VO2 max of 51, and a strong family history of heart disease. He also has measurable plaque in his coronary arteries. In this solo episode, he walks through the raw data from his own serial heart scans, explains why he started a PCSK9 inhibitor, and delivers a nuanced, data-heavy case for why the most dramatic number from his scans—a 48% plaque reduction—is likely not the most important one.

The Plaque Problem: Why a Healthy Diet Isn't a Guarantee

The episode’s central tension is introduced by a commenter: "How did he get plaque in the first place if all he eats is vegetables?" Hill’s answer has three parts. First, he did not always eat this way. For the first 30 years of his life, he ate a standard Australian omnivorous diet, and his LDL cholesterol sat around 125 mg/dL. Plaque, he explains, is about "cumulative exposure"—the area under the curve of how high your cholesterol has been for how long. Changing his diet at age 30 brought his LDL into the 70s, but it did not erase the prior three decades of exposure. "Plaque doesn't just reset when your diet does," he says.

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What you'll learn

  • 1 (00:06) **Why This Episode Exists** - Simon explains that after sharing his dramatic 48% plaque regression, the top question was "how did you do this?" and that this episode is the answer.
  • 2 (03:33) **Why He Had Plaque Despite a Healthy Diet** - Three reasons explain why someone eating a plant-based diet can still have atherosclerosis.
  • 3 (12:00) **The Glagov Trial and Why Lower is Better** - The key evidence that drove Simon's decision to target a lower ApoB.
  • 4 (13:22) **His Lifestyle Protocol Between Scans** - The specific diet, exercise, sleep, and supplement routine during the 16.5-month period.
  • 5 (25:48) **The Three Scan Analyses and Their Disagreement** - The same scans were analyzed by three different platforms, and they disagreed dramatically.
  • 6 (30:56) **Which Analysis He Trusts and Why** - Dr. Matthew Budoff, the cardiologist who performed the scans, favors the human-read QAngio analysis.
  • 7 (41:36) **Why He Started a PCSK9 Inhibitor** - Three reasons drove the decision to add medication on top of his lifestyle.

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Guests on this episode

Simon Hill

Show Notes

A few weeks ago I published my own heart scans, and one number travelled further than the rest: a 48% drop in plaque over 16 and a half months. The question underneath that video was the obvious one. How? This episode is the answer, and it is also the part I could easily have left out.

Three companies analysed the same two scans. HeartFlow found a 48% reduction, Cleerly found a 20% increase, and QAngio found essentially no change at all. Same heart, same images, and a sixfold spread in the absolute amount of plaque they measured. I walk through my full protocol, explain which analysis I anchor to and why, and tell you why, despite that headline, I have started a PCSK9 inhibitor.

What We Cover:

  • Why cumulative ApoB exposure matters more than the cholesterol reading you have today
  • My nutrition, training, and sleep protocol, and the supplements I deliberately avoided
  • Why three platforms measuring the same heart came back with 11.5, 60, and 74 cubic millimetres
  • The published concern about AI overestimation of plaque, and which analysis Dr Matthew Budoff trusts
  • How my percentile swings 25 points depending on the reference database
  • Why I started a PCSK9 inhibitor, and how I chose it over a statin
  • Why you should be sceptical of dramatic short-interval scan results, including mine

All three analyses agreed on the thing that matters: the plaque burden is low, and it is not progressing rapidly. That agreement is worth far more than the headline.

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