What percentage of total daily calories should come from good fat and total fat to achieve an LDL level of 55 mg/dL while taking ezetimibe (10mg) and pravastatin (40mg)?

Dietary Fat Recommendations to Achieve LDL 55 mg/dL on Ezetimibe 10mg + Pravastatin 40mg

To achieve an LDL of 55 mg/dL while taking ezetimibe 10mg and pravastatin 40mg, limit saturated fat to less than 7% of total daily calories and dietary cholesterol to less than 200mg per day, while emphasizing unsaturated "good fats" comprising 25-35% of total calories. 1

Expected LDL Reduction from Current Medications

Your medication regimen provides substantial but moderate LDL-lowering:

• Pravastatin 40mg is classified as moderate-intensity statin therapy, providing approximately 30-40% LDL reduction from baseline 2
• Ezetimibe 10mg adds an additional 15-25% LDL reduction when combined with pravastatin 3, 4
• Combined therapy (pravastatin 40mg + ezetimibe 10mg) achieves approximately 34-41% total LDL reduction 3

The IMPROVE-IT trial demonstrated that simvastatin 40mg plus ezetimibe 10mg achieved mean on-treatment LDL levels of 53.2 mg/dL, which is very close to your target 2

Specific Dietary Fat Recommendations

Saturated Fat Limits

• Keep saturated fat below 7% of total daily calories 1
• For a 2000 calorie diet, this equals approximately 15 grams of saturated fat per day
• Primary sources to limit: red meat, full-fat dairy, butter, tropical oils (coconut, palm)

Total Fat Composition

• Total fat should comprise 25-35% of total daily calories 1
• For a 2000 calorie diet, this equals 55-78 grams of total fat per day
• Emphasize unsaturated fats (monounsaturated and polyunsaturated) as the majority of fat intake

"Good Fat" Emphasis

• Monounsaturated fats: 15-20% of total calories from sources like olive oil, avocados, nuts 1
• Polyunsaturated fats (including omega-3): 8-10% of total calories from fatty fish, walnuts, flaxseed 1
• Dietary cholesterol: limit to less than 200mg per day 1

Critical Medication Considerations

Important caveat: Pravastatin 40mg is moderate-intensity therapy, not high-intensity 2. If you're not achieving your LDL target of 55 mg/dL despite optimal diet and current medications:

• Consider switching to high-intensity statin (atorvastatin 40-80mg or rosuvastatin 20-40mg) which provides ≥50% LDL reduction 2
• If LDL remains elevated after 4-6 weeks on maximally tolerated statin plus ezetimibe, adding a PCSK9 inhibitor is recommended to achieve the <55 mg/dL target 2

Practical Implementation Algorithm

1. Calculate your baseline LDL before starting medications to determine if 34-41% reduction will achieve 55 mg/dL target
2. If baseline LDL was >135 mg/dL, your current regimen may be insufficient even with perfect diet
3. Implement dietary changes immediately: saturated fat <7%, total fat 25-35%, cholesterol <200mg/day 1
4. Recheck lipids in 4-6 weeks after dietary optimization 2
5. If LDL remains >55 mg/dL, discuss upgrading to high-intensity statin with your physician 2

Common Pitfall to Avoid

Do not assume diet alone will compensate for inadequate medication intensity 2. The 2020 ESC and 2025 ACC/AHA guidelines clearly state that achieving LDL <55 mg/dL in very high-risk patients (such as those with acute coronary syndrome) requires maximally tolerated statin therapy PLUS ezetimibe, and often requires PCSK9 inhibitors 2. Dietary modification is essential but adjunctive to appropriate pharmacotherapy 1.