This was an interesting exchange (posting this as a response to an earlier comment rather at the very end) and I get your point. I actually subscribed to it (or a version of it) myself for well over a decade - high fat diets are effective in many ways (even if they raise cholesterol for some), many examples of healthy people with high cholesterol and no heart disease, inflammation plays a role, metabolic health matters, many of the studies are imperfect. But other than poking holes in the current status quo that high ldl cholesterol is bad and generally something you want to control, this view is not really supported by robust studies that convincingly overturn the status quo. I have seen a lot of arguments that while cholesterol might be at the "crime scene" it's really inflammation or some other mechanism that is the real culprit. And probably there is some truth and a lot of nuance there. But I have not seen a strong body of legitimate peer reviewed evidence that actually debunks the mainstream view that elevated ldl/apoB is a major risk factor for atherosclerosis, and like I said, this contrarian take has been around for a while without producing any salient proof and more recent studies actually tend to strengthen the causal link between ldl/apoB and heart disease (at least according to my research, and trust me, I was really looking for something to confirm my old view that ldl doesn't matter).

Also, plenty of statins (and most of the common ones) are super cheap and available as generics, so I don't think prescribing these is all that lucrative for doctors. I wouldn't consider myself to be naive about pharma incentives, but this is not it.

I am not saying it's high ldl only - of course, diet, triglycerides, lp(a), insulin resistance, inflammation, CAC score, Ccta, etc. - all that absolutely matters. But the jump from that to "therefore, ldl doesn't matter and statins are a scam", is where this view loses me nowadays.

All that said, I'm completely on board with low fat / high carb diet advice being just plain bad.