Effects of morning vs evening statin administration on lipid profile: A systematic review and meta-analysis.

Kamal Awad, Maria-Corina Serban, Peter Penson, Dimitri P Mikhailidis, Peter P Toth, Steven R Jones, Manfredi Rizzo, George Howard, Gregory Y H Lip, Maciej Banach

Journal: Journal of clinical lipidology 2018;11(4):972-985.e9

PMID: 28826569

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

Evidence about the optimal time of day at which to administer statins is lacking.

OBJECTIVE

The objective of this study is to synthesize evidence about effects of morning vs evening statin administration on lipid profile.

METHODS

We searched PubMed, SCOPUS, Web of Science, and Embase databases (from inception up to July 24, 2016) to identify the relevant studies. Mean differences (MDs) between the change scores in lipid parameters were pooled using a fixed-effect model.

RESULTS

Eleven articles with 1034 participants were eligible for the analysis. The pooled analysis comparing effects of morning vs evening administration of statins on plasma total cholesterol (TC; P = .10), high-density lipoprotein cholesterol (P = .90), and triglycerides (P = .45) was not statistically significant. Low-density lipoprotein cholesterol (LDL-C) lowering was statistically greater in the evening-dose group (MD: 3.24 mg/dL, 95% CI: 1.23-5.25, P = .002). Subgroup analysis according to statin half-lives showed that evening dose of statins was significantly superior to morning dose for lowering LDL-C in case of both short and long half-life statins (MD: 9.68 mg/dL, 95% CI: 3.32-16.03, P = .003 and MD: 2.53 mg/dL, 95% CI: 0.41-4.64, P = .02, respectively) and also for TC reduction in case of short half-life statins only (P = .0005).

CONCLUSIONS

LDL-C and TC lowering was significantly greater in the evening dose than in the morning dose in case of short-acting statins. Besides slight but significant effect on LDL-C, the efficacy of long-acting statins was equivalent for both regimens. Therefore, long-acting statins should be given at a time that will best aid compliance. Short-acting statins should be given in the evening.

Address: Faculty of Medicine, Zagazig University, Zagazig, El-Sharkia, Egypt; Student Research Unit, Zagazig University, Zagazig, El-Sharkia, Egypt. Electronic address: [email protected].; Department of Functional Sciences, Discipline of Pathophysiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.; School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, United Kingdom.; Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London, United Kingdom.; Preventive Cardiology, CGH Medical Center, Sterling, IL, USA; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.; Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy.; Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.; Department of Hypertension, Medical University of Lodz, Lodz, Poland; Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.

DOI: 10.1016/j.jacl.2017.06.001