If statins can reduce total cholesterol to 150 or below, what incentive is there to change the diet in ways that naturally reduce cholesterol levels?

Back in the1980s and 90s, physicians were taught that there were two kinds of cardiac risk factors: modifiable and non-modifiable. Non-modifiable risk factors were: age, genetics, past history and gender.
Modifiable risk factors were: smoking, blood pressure, blood sugar, weight control, saturated fat intake, exercise, and cholesterol.
Cholesterol gave quantifiable numbers that provided everyone a solid sense of accomplishment: we were really doing something to save and (prolong) life.
A major push towards addressing these health issues was made and cholesterol was given certain numeric targets, almost always achieved through the use of statins.
There were some people who had extremely high cholesterol and they were diagnosed with familial hypercholesterolemia syndromes. These patients generally had a family history of early cardiac deaths, in the 20s, 30s and 40s.   Mostly adults but some of these patients were Pediatric patients and were started on statins at a young age.
These people constituted a small percentage of the general population. Other (most) people merely had moderate to significant elevations in cholesterol.
There was unquestionably an association between cholesterol and heart disease and we were led to believe by the science and the pharmaceutical companies that cholesterol caused heart disease.
Following the guidelines was considered the usual and customary practice.
In 1991 or 92,  a Merck drug rep (an R.Ph) who was selling Zocor any told me a story about what happened in New Orleans in 1991 at the American College of Cardiologists who were having a big meeting, "off the record" wink wink nod nod.
He told me they drew lots of Cardiologist's blood and tested it for cholesterol and found that the average total cholesterol was 110!!
He said that the cardiologists were taking this medicine like candy because they firmly believe that lower was better. 
Then he said: "better living through chemistry."  
That triggered a nerve, (as explained below) so..... 

I asked him two questions:

1.  Why and how was Zocor, his new =expensive statin better than the existing= cheaper statin that at the time I believe was Mevacor.

2.   At what point would the cholesterol be so low that it would slow or stop the formation of cortisone, androgens, estrogens, mineralocorticoids and vitamin D?  (Today Co Q10 would have been added to the concerns)

He hit a nerve so I decided to engage him, for his, my office staff and my edification and (my) anticipated mischivous amusement.  

Admittedly, I held an advantage that only an undergraduate chemistry degree can afford: chemistry 1 and 2, organic 1 and 2 (twice!), biochem 1 and 2, physical chemistry and quantitative analysis. He had an RpH.

His responses were simple:

1.  $3,200,000,000.00. USD.   
3.2 billion dollars profit for his company for his statin, he winked and asked if I owned any stock in his company  (I did not).


2.  His response to my technical questions was to throw lots of studies: random control double-blind chi-square analysis and other fancy statistical jargon far beyond my ken. Studies that have been done by very prestigious institutions with a whole lot of money and a whole lot of people a whole lot smarter than me.  Town vs Gown$.  
Many of these studies of course were funded by the pharmaceutical company because that's where the money was. "Publish or perish" was/is a tenent of academia: if you do publish you bring money and prestige to the Institution.  Or, in retrospect, some outrageous and unethical "re$earch" to be uncovered at some later date. 

I prescribed statins to hundreds of patients in a rural primary care setting, with an outstanding University Cardiologist (Thanks A.T., M.D.) for back up. Patients generally responded to statins in one of several fashions.
1.  one group of patients took them without difficulty, complaint, side effect or any noticeable untoward action.  Their cholesterol numbers reached goal.The patients also were mindful of all the other modifiable risk factors, the ripple effect. 
2.   this group of patients got almost immediate muscle pain (myalgias) and/or joint pain (arthalgias) and generally these patients were switched to a different statin.
Sometimes they tolerated this, other times not. If not it was a class affect:  every drug in the statin class caused muscle/joint pain.
3.   this group of patients complained of problems with memory loss and organizational skills that today we would call executive function. 
Often times spouses and business associate commented on this decline and it was generally assumed to be part and parcel of the medications; because there were multiple meds polypharmacy often times involved minimizing the side effects as much as maximizing the medication benefits.
4.  this group takes statins and has longterm isolated chronic musculoskeletal pain, tendons, ligaments,  muscles, joints, etc. today it would likely resemble fibromyalgia.

So it seems pretty clear: when people have familial hypercholesterolemia or if they have multiple other modifiable or non-modifiable cardiac risk factors that are not addressed then cholesterol becomes more important in the grand scheme of decision-making if the side effects are tolerated. y
The same notion applies (and to a greater extent) if somebody has had a heart attack, stent, bypass graft or other significant cardiac intervention/issues. For these people the benefits of the statins may markedly outweigh the risks of these side effects. 
For most people two-thirds of their cholesterol (more or less) comes from their non-modifiable hereditary background, and the balance comes from diet.  
One patient, a 50 something year old farmer, lowered his total cholesterol from 330 to 200 with significant dietary and lifestyle modification, and avoided statins.
Some octogenarian patients present with lab work showing HDL cholesterol in the high 90s or 100s and total cholesterol in the low to mid 200s and they're taking a statin. With no cardiac history and few risk factors,  it's not clear that the statins benefit's outweigh the confusion and memory loss that occurs.
Anyone who has a cardiac history and is taking a statin absolutely should consider taking Co Q10, ubiquonol (preferred formulation of CoQ10 over ubiquonone). 200 per day is a reasonable dose, to be taken with oil for optimal absorption. 
Co Q10 is in addition to all the other essential nutrients.

Medicine and Healthcare are ever-changing fields; Fuller's Law dictates that it is impossible to keep up as the amount of information doubles every year, soon even faster! 

I hope this information is not out-of-date by the time you finish reading it but that's the chance we all must take.

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