When the benefits outweigh the risks. These two grafs stuck out to me:

My decision to take a statin was not made casually. I first tried a stricter-than-usual diet of home-cooked meals rich in vegetables plus fish and nearly devoid of saturated fats, processed foods and refined carbs and sugars. I took supplements of fish oils, fiber and plant sterols, among other nonprescription products said to lower cholesterol. And, of course, I kept my weight down and activity up — a daily regimen of walking, swimming and cycling. All, alas, to no avail. [Emphasis added]

So if she’s only eating fish, it’s likely that she’s not getting enough protein. She doesn’t explain why she’s not eating land animals. And she seems to think that saturated fat is harmful, when there’s no scientific evidence that consumption of it either increases cholesterol, or health risks. There’s also not much evidence that exercise controls cholesterol. Next:

…for those facing a higher-than-average risk of suffering a heart attack or stroke, the first step in reducing that risk is not a drug but getting modifiable risk factors under control. Even if you plan to take a statin, the drug will be most effective when combined with measures that reduce cardiovascular risk.

That means adopting and sticking to a Mediterranean-style diet that emphasizes fruits, vegetables, peas and beans, nuts and seeds and contains little or no saturated fats, the fats found in meats, poultry and dairy products that are not fat-free. Substitute whole grains for refined ones. The best oils to use for cooking and salads are olive, canola, grapeseed and avocado.

So she’s recommending eschewing animal products in general, and (again) eliminating saturated fats, with their healthy omega 3s. And substituting seed oils (canola and grape), with their high omega 6s for them, promoting inflammation. She also imagines that whole grains are all right, when refined aren’t when (again) there is little scientific evidence to support it.

One other point: This is exactly the kind of uncontrolled experiment that gives us so much junk nutrition science (e.g., she didn’t try a high-meat, high-fat, low-carb diet; she just assumed that the one she was on was best to lower cholesterol, then gave up and switched to taking statins).

Given that I have never had a cardiovascular event, I think I’m going to stick with my current meat-rich (and saturated-fat-rich) diet, and continue to eschew statins.