Cholesterol has an essential role to play in our bodies. It is an important component of cell membranes, aids in the production of several hormones and vitamins, and assists the liver in bile production. However, too much cholesterol can be detrimental to our health and may require medication.
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There are two types of cholesterol: HDL referred to as ‘good’ cholesterol, and LDL, which is ‘bad’ cholesterol.
HDL cholesterol helps to absorb and carry LDL cholesterol out of your arteries and flush it from your body.
LDL cholesterol can build up in the walls of your arteries, causing them to become stiff and narrow, reducing or blocking blood flow. High LDL cholesterol may cause chest pain, stroke, or heart attack if left untreated.
High cholesterol can be the result of many factors, including a diet high in saturated fat, lack of exercise, smoking, high alcohol intake, and stress. It can also be hereditary or a combination of both.
Sometimes diet, exercise, and lifestyle changes alone are not enough to treat high cholesterol, so your doctor may recommend cholesterol medication to help. The most common medication prescribed is a drug class called statins.
Statins are designed to help lower cholesterol by blocking the cholesterol-making enzymes in the liver. This slows down the production of cholesterol. Some statins also work to increase your HDL cholesterol.
An important piece of information about statins is their half-life. The half-life of a statin is the time it takes for the active substance of the medication to decrease by half in your body.
The half-life provides precise information about how long a medication persists in your body when a drug will be most effective, and how fast the drug is eliminated from your body to help avoid an overdose. The half-life of a drug varies from person to person, although the difference is usually small.
Each statin can be considered as either having a short half-life or a long half-life:
A statin that has a short half-life, also known as a short-acting statin, tends to act very quickly within your body, but its effects also wear off quickly.
A statin with a long half-life, also known as a long-acting statin, may also act straight away, or it may take some time, but its effects last much longer.
Examples of common short-acting statins (generic names):
Examples of common long-acting statins (generic names):
The degree of LDL cholesterol reduction is dose-dependent and varies between each statin. Each one has either low, moderate, or high intensity, depending on the dose and to what degree it can lower your LDL levels. High-intensity statins can lower your LDL levels by 50% or more.
How often you take your statin will vary depending on the type you are taking and your individual situation.
Our body's cells, tissues, organs, and systems are more sensitive and active at different times of the day. For this reason, taking your cholesterol medication may have a big impact on your cholesterol levels and overall health.
Taking your cholesterol medication at the optimal time will increase its effectiveness and potentially decrease the side effects you may experience. This, in turn, makes you more likely to take your medication.
Research has shown that the best time to take cholesterol medication is in the evening, around bedtime.
LDL cholesterol production tends to be highest at night and lowest in the early morning and afternoon, so slowing down the cholesterol-making enzyme when it is most active may mean less LDL cholesterol produced.
The timing of medication administration does not affect HDL cholesterol production levels.
A study¹ shows that short-acting statins might work better if taken in the evening, and long-acting statins and those statins absorbed more slowly by the body can be taken at any time of day.
Most short-acting statins, particularly those that have half-lives of less than six hours
Taking lovastatin, simvastatin, and fluvastatin in the evening is beneficial in reducing LDL cholesterol levels, compared with taking them at any other time of day
Most long-acting statins, particularly those that have a half-life of over seven hours
Atorvastatin, rosuvastatin, and extended-release fluvastatin can be taken at any time of day
Pravastatin can be taken at any time of day, despite its short half-life
More research about the best time to take cholesterol medication is still needed to say for sure, so refer to the advice of your doctor. If there is a time of day you prefer to take your cholesterol medication, then this can be discussed. It is better to remember to take your statin at your preferred time every day than to take it irregularly or not at all.
In some cases, the use of non-statin medicines to treat high cholesterol is required, the most common being ezetimibe. Ezetimibe can help lower LDL cholesterol by absorbing dietary cholesterol in the gut.
Ezetimibe may be prescribed alongside a statin if you have suffered a heart attack or stroke or your lipid levels are not able to be optimally controlled by statins.
You should only take ezetimibe at the same time as statins or other cholesterol medications if your prescribing doctor has directed you to do so, as it could lead to illness or toxicity.
Ezetimibe may be prescribed as an alternative if a statin is intolerable or unsafe for you. Please consult your doctor or healthcare provider before taking ezetimibe.
Taking your statin in the evening may be more effective in lowering your LDL cholesterol and reducing your experience with side effects.
However, the most important thing is that you take your statins once daily, whether at night or whenever you are most likely to remember to take them.
AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American college of cardiology/American heart association task force on clinical practice guidelines (2019)
Lipid-lowering drugs (2006)
Timing when to take your daily medications | American Association of Retired Persons (AARP)
Statin toxicity (2019)