Taking Statin Medication – Timing Can Matter

Remembering to Take Your Statin Medication

By John A. Rumberger, PhD, MD, FACC, FSCCT
Director of Cardiovascular Imaging, Princeton Longevity Center

The group of prescription medications called ‘statins’ have been available in a variety of formulas since the early 1990’s.  The first statin medication, Lovastatin or Mevacor, clearly showed a major reduction in cardiac mortality and morbidity by 30% at 18 months after starting the medication.  This was followed by numerous studies with other formulations confirming the initial results and expanding the general use of statins in patients with known or suspected heart disease.

What are the mechanisms by which statins work? Statins interfere with a vital step in the cholesterol assembly line in the liver by inhibiting the production of a chemical called HMG-CoA Reductase.  But this is NOT the primary means by which statin lower circulating cholesterol.  The liver itself responds to the lowering of the cholesterol reduction by increasing its production of what are called ‘LDL-Receptors’ [or low density lipoprotein ‘bad cholesterol’ receptors].  These receptors at the surface of the liver/blood interface ‘grab’ circulating LDL particles and take them into the center of the liver where they both are destroyed.  This is the primary mechanism with which statins lower circulating cholesterol [and in particular the most important component for heart disease, the LDL-cholesterol].  Statins also have what we call ‘pleomorphic’ effects that can lower inflammation at the site of the developing atherosclerotic plaque and promote healing.

The current list of available statin medications is shown in the table here:

Originally, doctors were told to prescribe the statins at bedtime.  The supposed mechanism was that the production of cholesterol was the highest when you slept.  So, as the newer and more powerful statins came along, we continued to prescribe the medications at bedtime; but there is an important factor here in the ‘pharmacodynamics’ and break-down/metabolism of prescription medications.  That factor is called ‘half-life’ and gives an idea of how many hours after taking the medication is active in the body.

It turns out that Lovastatin had a half-life of 6 hours and thus it was vital that it be taken during the timing of increased cholesterol production by the liver.  However the more modern medications such as Atorvastatin have a half-life of 13 hours and for Rosuvastatin the half-life is 18 hours.  Thus with the latter two medications, they can be clinically effective essentially whenever they are taken during the day.

Why is this so important?  Because we are all human and it can be routine to take your other medications or supplements in the AM and ‘remembering’ to take your statin medication at bedtime – simply is not routine.

In our practice at the Princeton Longevity Center, when we prescribe statins for a patient, we use either Atorvastatin or Rosuvastatin and advise taking the medications at night – but in reality taking them in the AM along with other meds and supplements is just fine.