Americans, on average, eat a diet much higher in fat and protein than many other cultures including the Japanese. The Japanese (not the ones who have become Westernized in their diet) eat a diet high in starches (rice) and vegetables with small amounts of meat (mostly fish). The Japanese have much lower rates of heart disease, certain cancers, diabetes, and strokes as compared to Western cultures. So do the non-Westernized Chinese and some South American and African cultures (See The China Study by TC Campbell, Ph.D.).
I think that it is well accepted by most physicians that high cholesterol increases the risk of heart disease. Most people can reduce their cholesterol levels by eating a low fat diet (<15% of total calories). There are a few who have a high cholesterol condition that does not respond to diet and must be treated with medication. Drs. Ornish, Esselstyn and others have demonstrated through their peer-reviewed and well published research that heart disease can be prevented and reversed with a low fat plant-based diet with no side effects and little or no medications (and low expense). Doctors don't push low fat diets for many reasons included the concern that people wouldn't stick to a low fat eating program. There are a few, like Dr. Atkins and the author of The South Beach Diet, who dispute the value of a low fat diet. My vote is with Drs. Ornish, McDougall, Barnard, Campbell, and Esselstyn. Their research is pretty convincing.
Statins are effective in lowering cholesterol, but there are side effects and Statins don't address the fundamental problem - a rich diet. i wouldn't take Statins unless my low fat plant-based diet didn't lower my cholesterol. So far, the diet has worked. The liver produces lots of cholesterol, all that we need. There is no reason to add cholesterol to our diet. I suspect that those doctors that say cholesterol doesn't matter, are in a tiny minority of the medical community.
A low fat diet that includes the NEW four food groups -- vegetables, fruits, legumes and whole grains ( see Neil Barnard, MD, Food for Life) is very well balanced and has between 10-15% of calories from fat. An acquaintance of mine wins age-group Ironman Triathlons on this diet. She is 72 years old. She firmly believes, and I agree, that exercise, while important, is not as important as diet. Marathoners who eat a rich diet are more at risk than Marathoners who eat a healthy diet. Remember Jim Fixx.
Wouldn't it be nice if the medical profession reached consensus? We are left sorting through all of this by ourselves. And so, it comes down to "different strokes for......." and who do you believe?