Causes and Solutions

THE ORTHODOX  APPROACH
The American Heart Association suggests in general not to take supplements, to limit saturated fats and to eat less than 300 mg cholesterol per day.  However:

1.  It has never been shown that not taking supplements improves health and helps prevent heart disease, or any other disease for that matter.
2.  In the real world, very low-cholesterol diets fail to significantly raise good or lower bad cholesterol in high-risk people
3.  Many foods with cholesterol (liver and eggs) have key vitamins, proteins and other nutrients.
4.  Groups can have 4 times more heart disease despite 10% less 'bad' cholesterol ... while over age 65, cholesterol is no risk-factor anyway (low cholesterol is!).
5.  Low saturated-fat diets may be dangerously low in vitamins A, E and omega-3 --while some saturated fats (butter and coconut) can have health benefits.
6.  Benefits of drug-based prevention are poorly documented and results uncertain:

Two classic studies:
1. After 2 years most (75%) of the not-treated patients "remained free of major cardiac events" but only 57% of those told to avoid animal fat, dairy, butter, eggs, fried food and cholesterol but given olive oil, and only 52% of those on the same restrictions given (omega-6) corn oil.  Conclusion: ...under the circumstances of this trial corn oil cannot be recommended in the treatment of ischaemic heart disease." [Br Med J; June 1965 (1): 1531-3].
Predictably the corn oil group had less cholesterol but little good that did!  While this trial clearly suggests harm, it proves with 99% probability the lack of benefit of these dietary changes [...and of low cholesterol levels per se].

2. The large U.S. "Veterans Trial" (corn oil) found slightly less heart disease wiped out by doubled cancer deaths (58.4 +/-0.6% survivors after 8 long years; Circ.; 1969 (40): Suppl. II and Pearce and Dayton in Lancet; '71: 464-7).  94 out of 100 similar studies would find more cancer after 8 years --which is more "cancer-causing" than smoking for 8 years!

There is no benefit in failure so there were no subsequent high-linoleic "omega-6 polyunsaturate" trials.  Corn, soy, sunflower, safflower and cottonseed oils all have between 51-75% linoleic.  This stuff winds up in your arteries, making "plaque" more fragile (not good).

The omega-6 / cancer link reappears regularly, as in the Israeli Paradox this country's very high omega-6 (soy) and low animal fat intake should produce little heart disease but instead there are respectively 1.5, 2.3 and 3.4x higher rates of diabetes, heart disease and cancer in Jewish versus non-Jewish Israelis.  P.S. Omega-3 studies with fish or canola do have happier results.

One sad example of medical prevention involved intensive cholesterol and blood pressure lowering drugs and 15 doctor visits over 5 years.  Five years after the trial 50% more treated men had died (67 vs 46) and 2½ times more cardio-deaths had occurred (34 vs 14) than in the untreated half of 1222 high-risk Finnish men JAMA; '91-9-4.  Is there evidence that, 20 years later, your drugs and your doctor are better than those in Finland?  Ask your doctor but mention the famous The Lancet; Aug. 29 '98: "Despite reductions in the age-related incidence of myocardial infarction and improved control of blood pressure the prevalence of heart failure does not seem to be falling and may be rising."  This reference concerns heart failure and reveals the current state of medical "management" and prevention of heart conditions: not great.