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> Heart disease progresses over decades <...> You don't want to wait til you're 18 months out from a heart attack to do anything. I don't think this is good advice

Correct. The idea is commonly referred to as "LDL-C Burden"

https://jamanetwork.com/journals/jamacardiology/fullarticle/...

> no solid evidence it can be reversed

We do see good evidence of soft-plaque regression with very low levels of LDL-C, generally in patients undergoing high dose statin therapy or combo therapy.

https://www.jacc.org/doi/10.1016/j.jacc.2021.10.035 https://jamanetwork.com/journals/jama/fullarticle/2584184 https://pmc.ncbi.nlm.nih.gov/articles/PMC7644491/

We don't have any real evidence of effective/widely-applicable treatments to reduce calcified plaque, though.



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