Vitamin K2 is often marketed as if it reliably “reverses plaque.” But when we narrow the question to soft plaque — not calcified plaque, and not overall cardiovascular disease — the evidence is much less convincing. Most randomized trials looking at soft plaque used carotid intima-media thickness, or CIMT, as a surrogate marker of plaque burden. Across the trials I reviewed, the pattern was roughly: 4 studies: no clear effect 2 studies: possible benefit That does not mean vitamin K2 is useless. It means the evidence is not strong enough to claim that vitamin K2 reliably removes soft plaque. The studies showing possible benefit tended to involve higher-risk groups, including people with chronic kidney disease, type 2 diabetes, coronary heart disease, or metabolic dysfunction. So it is possible vitamin K may matter more in metabolically compromised people. But even that is not settled, because the results are mixed. Dose, form of vitamin K, dosing frequency, study length, baseline risk, and co-supplementation may all matter. Main Points Vitamin K2 may have potential benefit for soft plaque in select high-risk groups. But the totality of randomized evidence does not support the popular claim that vitamin K2 reliably reverses soft arterial plaque. And that distinction matters. Soft plaque, calcified plaque, and cardiovascular disease risk are not the same outcome. A supplement can affect one marker, fail to affect another, and still have uncertain relevance to real-world events. References Vlasschaert et al. Nutrients. 2020. doi:10.3390/nu12102909 Knapen et al. Thromb Haemost. 2015. doi:10.1160/TH14-08-0675 Braam et al. Thromb Haemost. 2004. doi:10.1160/TH03-07-0423 Kurnatowska et al. Pol Arch Intern Med. 2015. DOI not listed. De Vriese et al. JASN. 2020. doi:10.1681/ASN.2019060579 Hasific et al. JACC Adv. 2023. doi:10.1016/j.jacadv.2023.100643 Asemi et al. Br J Nutr. 2016. doi:10.1017/S0007114516001847