Editor—For a general practitioner the article by Wallace et al on timing of simvastatin was clearly relevant to everyday practice, but I do not think that it really answers the question.1 The samples were taken when patients were fasting (as before) but, by changing to dose timing, any diurnal variation in the fasting lipid profile could account for the differences.
Any similar diurnal variation may occur with morning dosing but, because of the proper practice, lipid samples are not taken 12 hours later in the non-fasting situation.
The implication could be therefore not to change the timing of drug treatment but switch to atorvastatin. This, however, would be true only if there is long term advantage. I am not aware of any, and this study does not answer that question.
As acknowledged in the second paragraph, compliance benefits from morning dosing along with other drugs, and I would not, on the basis of this article, change my patients' dosing around.
Competing interests: None declared.
References
- 1.Wallace A, Chinn D, Rubin G. Taking simvastatin in the morning compared with in the evening: randomised controlled trial. BMJ 2003;327: 788. (4 October.) [DOI] [PMC free article] [PubMed] [Google Scholar]