Long-acting statins are also effective when taken in the morning
Effects of Morning Versus Evening Statin Administration on Lipid Profile: A Systematic Review and Meta-AnalysisLiterature - Awad K, Serban MC, Penson P, et al. - Journal of Clinical Lipidology 2017; published online ahead of print
- Only 11 articles published between 1986 and 2014 were eligible for the meta-analysis: these included 12 treatment arms and 1034 participants, with a study duration of 4 to 12 weeks. Statin doses used were: 40 mg/d atorvastatin, 2.5 to 20 mg/d simvastatin, 10 mg/d rosuvastatin, 20 mg/d lovastatin, 40 mg/d pravastatin and 80 mg/d fluvastatin.
- The overall pooled analysis comparing effects of morning vs evening administration of statins on TC, HDL-C and TG were not statistically significant, but it favored the evening administration of statins on LDL-C. Mean differences were: TC: 1.68 mg/dL (95% CI: -0.33 to 3.69; P=0.10), HDL-C: 0.05 mg/dL (95% CI: -0.77 to 0.87; P=0.90), TG: 1.66 mg/dL (95% CI: -2.68 to 5.99; P=0.45) and LDL-C: 3.24 mg/dL (95% CI: 1.23–5.25; P=0.002).
- The pooled analysis of the short half-life statins subgroup did not reveal any significant difference between the morning-dose and evening-dose groups in terms of HDL-C and TG, but it favored the evening dose over the morning dose in terms of TC and LDL-C. Mean differences were: HDL-C: 0.28 mg/dL ( 95% CI: -1.49 to 2.06; P=0.75), TG: 0.97 mg/dL (95% CI: -13.54 to 15.48; P=0.90), TC: 12.10 mg/dL (95% CI: 5.25–18.95; P=0.0005), LDL-C: 9.68 mg/dL (95% CI: 3.32 -16.03; P=0.003).
- The pooled analysis of the long half-life statins subgroup did not show any significant difference for TC, HDL-C or TG, but it slightly favored the evening dose over the morning dose for LDL-C. Mean differences were: TC: 0.70 mg/dL (95% CI: -1.40 to 2.80; P=0.51), HDL-C: -0.01 mg/dL (95% CI: -0.94 to 0.92 P=0.98), TG: 1.72 mg/dL (95% CI: -2.82 to 6.27; P=0.46), LDL-C: 2.53 mg/dL (95% CI: 0.41–4.64; P=0.02).
- Out of 3 studies that reported compliance rates, 1 study indicated that compliance was better when treatment was taken in the morning, compared with the evening, whereas the other 2 studies were neutral in terms of compliance.
Short-acting statins are significantly more effective in lowering LDL-C and TC when they are administered in the evening, rather than the morning, whereas long-acting statins had a nearly equivalent efficacy irrespective of timing of administration during the day, with the exception of a small but statistically significant effect on LDL-C. These findings confirm that short-acting statins should be taken in the evening and the authors suggest that long-acting statins can also be taken in the morning, if this facilitates patient compliance.