Total Fat Intake for Achieving LDL-C <70 mg/dL
For patients with hypercholesterolemia on pravastatin and ezetimibe aiming for LDL-C <70 mg/dL, limit total fat to 25-35% of total calories, with saturated fat <7%, trans fat <1%, and the remainder from unsaturated fats (monounsaturated and polyunsaturated). 1, 2
Specific Fat Distribution Guidelines
Saturated Fat: <7% of total calories (as you've already identified) 1, 2
Trans Fat: <1% of total calories (essentially zero, as you've identified) 1
Total Fat: 25-35% of total calories 2
- This range allows adequate intake of essential fatty acids while maintaining cardiovascular health
- The majority should come from "good fats" (unsaturated sources)
Unsaturated Fats (the "good fats"): Should comprise 18-28% of total calories 2
- Monounsaturated fats (olive oil, canola oil, avocados, nuts): These should be emphasized as they lower LDL-C without adversely affecting HDL-C 2
- Polyunsaturated fats (corn oil, peanuts, fatty fish): Include omega-3 fatty acids from fish or fish oil capsules (1 g/day) for additional cardiovascular risk reduction 1, 2, 3
Additional Dietary Enhancements Beyond Fat Restriction
To maximize your chances of achieving LDL-C <70 mg/dL with your current medication regimen, add these evidence-based dietary components:
- Plant stanols/sterols: 2 g/day for additional LDL-C lowering 2, 3
- Viscous fiber: >10 g/day for further LDL-C reduction 2, 3
- Fresh fruits and vegetables: Increase consumption 2
- Low-fat dairy products: Emphasize these over full-fat versions 2
Why This Matters for Your LDL-C Goal
The combination of pravastatin and ezetimibe with optimal dietary modification is highly effective. Studies show that low-dose pravastatin (10 mg) plus ezetimibe (10 mg) reduces LDL-C by approximately 26% (from 158 mg/dL to 117 mg/dL), with total cholesterol dropping 25% 4. The addition of strict dietary modification as outlined above provides incremental benefit to help you reach the <70 mg/dL target 5, 4.
If you don't achieve LDL-C <70 mg/dL on maximally tolerated pravastatin plus ezetimibe with these dietary changes, intensification with a PCSK9 inhibitor becomes reasonable. 1 However, the dietary modifications outlined above should be implemented first, as they provide meaningful additional LDL-C lowering beyond medication alone 2, 3.
Practical Implementation
Calculate your total daily calories, then:
- Saturated fat: <7% of calories (if eating 2000 calories/day = <15.5g saturated fat)
- Trans fat: Essentially zero (<1% = <2.2g, but aim for 0g)
- Total fat: 25-35% of calories (if eating 2000 calories/day = 55-78g total fat)
- Unsaturated fats: The difference between total fat and saturated fat (approximately 40-62g if eating 2000 calories/day)
Common pitfall: Don't replace saturated fats with refined carbohydrates, as this can worsen triglycerides and doesn't improve cardiovascular outcomes. 2 Replace saturated fats specifically with unsaturated fats from the sources listed above.