There are genetics that play a large role in whether a person lays down plaque and high ldl is just one of the risk factors, I had high blood pressure at the time as well which I have under good control, as well as a family history that I did not mention before, both grandfather's had to have coranary bypass grafts in mid 60s. As far as plaque. When the lining of the vessel gets inflamed and micro damage occurs, whether from high blood pressure or some kind of inflamitory process. Cholesterol triglyceride, and fibrinogen can stick to the damaged areas, and over time this fatty substance becomes calcified. All of it is referred to as plaque. High ldl is a risk factor, as is low hdl, and high triglyceride. As far as I know some kind of inflamation of the vessel lining starts the process and once it gets started, the plaque that has formed is inflamitory enough to perpetuate the process. The body can also reduce the plaque that has been deposited over time when the risk factors are well controlled. Omega3 epa in high doses reduces inflamation, antioxidants reduce the oxidation of ldl, keeping BP less than 120/80, and getting lipids in more ideal ratios can all help reduce plaque that has developed when done together. This is my understanding of the issue. This is something that worries me personally due to my previous risk factors and family history. So I have been addressing all the risk factors I can control. Some of the supps I have been taking for the anti-inflamition and antioxidant effect. Omega 3s 8g, d3 5000iu, k2 150mcg, C 6g divided, ALA 1200mg divided, glycene 6g divided. Citrus bergamot extract 800mg. My hdl doesn't move much but my triglycerides and ldl are low. I keep my BP around 110/70, exercise and eat mostly minamally processed foods. I am just trying to do everything I can to stay healthy personally. Genetics aside.