What are statins?

What is the best time to take statins? To answer this question, we need to understand more about these HMG-CoA reductase inhibitors. Statins are medicines used to lower blood cholesterol levels. For this reason, they are among the most widely prescribed drugs.

Statins are used to treat the following indications:

  • Primary prevention of cardiovascular disease
  • Secondary prevention of cardiovascular disease
  • Primary hyperlipidemia

Statins are used for these indications because of their activity at HMG-CoA reductase; an enzyme involved in cholesterol production.

More specifically, statins inhibit this enzyme – the rate-limiting enzyme in the mevalonate pathway of cholesterol production. Statins are used to reduce the levels of harmful LDL (low-density lipoprotein) cholesterol, whilst also increasing the numbers of HDL (high-density lipoprotein) cholesterol – so-called “good cholesterol”.

Statins also have the effect of reducing triglyceride levels through an indirect means.

Taken together, statins are a highly effective means to reduce cholesterol levels and prevent risk of serious cardiovascular events, such as myocardial infarction and stroke.

Are statins safe?

Broadly speaking, yes, statins are reliably safe medicines.

Side effects associated with statins include:

  • Myopathies, including rhabdomyolysis
  • Gastrointestinal disturbances
  • Headache
  • Elevation of liver enzymes
  • Type 2 diabetes (in those with pre-existing risk factors).

Rarely, drug-induced hepatitis can occur.

Best Time to Take Statins

The short answer is – it depends.

It depends on whether the statin is a short or long-acting drug.

Put simply, most cholesterol production occurs at night. Hence, patients are routinely counseled to take statins in the evening; a time when cholesterol production is at its highest and when dietary intake of cholesterol is at its lowest.

Short-acting statins (most of which have half-lives around 6 hours) are more effective when taken in the evening.

These include:

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

By their very nature, long-acting statins exert their effects over a longer period, and so can be taken either in the morning or evening. Long-acting statins tend to have half-lives 3-times longer than short-acting drugs.

These include:

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

Short-acting drugs are frequently reserved for patients with a low risk of CVD, whereas longer-acting statins are more often used for patients with a higher risk of CVD.

Which Statin is Preferred?

Again, it depends upon a wide variety of clinical factors.

Among these factors include:

  • Existing cholesterol level of the patient
  • Whether they have a family history of CVD
  • Whether they have concurrent illnesses, such as diabetes
  • Lifestyle factors – such as alcohol and food consumption; smoking
  • Polypharmacy

The clinician takes these 5 factors into consideration to determine the most optimum treatment outcome for the patient – reviewing these factors alongside the available medicines – including combination medicines – to establish the most effective treatment plan for each patient.

Check back to our pharmacy blog soon for more great content on statins, CVD and other medical facts you need to know!