What are statins?

Statins are drugs used to lower blood cholesterol. Some statins work best when taken in the evening, whereas others work just as effectively when taken during the day. The best time to take statins, then, depends on each statin.

The purpose of statins is to reduce the risk of cardiovascular disease. Statins should not be the sole focus of treatment. Instead, patients are counselled to take statins alongside lifestyle modifications such as dietary changes, exercise, weight loss and smoking / alcohol cessation.

Of course, there are many different types of cholesterol.

Statins are used to reduce levels of low-density lipoprotein – or LDL – cholesterol; the variant of cholesterol responsible for generating atherosclerotic plaques. Once these plaques become dislodged, they can block blood vessels and lead to a myocardial infarction – one of the world’s leading causes of death.

Statins have proved to be enormously successful at reducing LDL cholesterol. That said, there are many different statins – each of which comes with its own pharmacokinetic and pharmacodynamic profile. This leads us, of course, to ask what the best time is to take statins.

Let’s answer this question by first dividing statins into short-acting statins and long-acting statins.

Short-Acting Statins

Not all statins are metabolised in the same way.

Studies show that short-acting statins work more effectively when taken in the evening. In contrast, patients who take short-acting statins in the morning are found to have greater levels of LDL and total cholesterol.

Why is this?

The enzyme that produces cholesterol is more active at night.

By taking short-acting statins in the evening, the drug has a higher concentration throughout the night to counter the effects of this enzyme. If the statin is instead taken in the morning, less active ingredient is available.

Short-acting statins include:

• Simvastatin (Zocor)
• Pravastatin (Pravachol)
• Fluvastatin (standard release)
• Lovastatin (Mevacor)

Most short-acting statins have a half-life of around 6 hours.

Long-Acting Statins

In contrast, long-acting statins have half-lives three times longer. As a result, more drug is available throughout both day and night to reduce cholesterol production.

Long-acting statins can be taken during the day or in the evening. Studies show that these medicines are just as effective at either time of day. That said, patients are counselled to take the medicine at the same time each day.

Long-acting statins include:

• Fluvastatin (extended release)
• Atorvastatin (Lipitor)
• Rosuvastatin (Crestor)

Long-acting statins may be prescribed if the patient has a high risk of cardiovascular disease. Alternatively, higher dosages may be used. Conversely, a short-acting statin may be used if the patient has a low risk of cardiovascular disease.

Which statin should be prescribed?

The statin chosen depends upon a wide variety of factors including:

• Patient’s cholesterol levels
• Family history of cardiovascular disease
• Concurrent pathologies, such as diabetes type 2
• Lifestyle factors, such as exercise and/or smoking
• Concurrent use of other medicines

With these details to hand, the clinician can decide what the optimum statin and dosage should be.

In conclusion then, the best time to take statins depends on the drug. Short-acting statins are best taken at night, whereas long-acting statins can be taken at any time of day. Short-acting statins are often used in patients with a low risk of cardiovascular disease, whereas long-acting statins are preferred in patients with a high risk of cardiovascular disease.