Intended for healthcare professionals

Rapid response to:

Primary Care

Taking simvastatin in the morning compared with in the evening: randomised controlled trial

BMJ 2003; 327 doi: (Published 02 October 2003) Cite this as: BMJ 2003;327:788

Rapid Response:

Serum cholesterol - a surrogate outcome

statins should be given in the evening or in the morning,1 if at all,
depends on whether it is advisable to lower cholesterol as much or as little as
possible. There is much evidence for the latter, because in all clinical2,3
and angiographic4 trials, where dose-response was calculated, the
outcome was independent on the degree of cholesterol lowering, indicating that
the effect of the statins is due to other mechanisms. In favour of the latter
view is also that in almost all cohort studies of old people high cholesterol
was not a risk factor for coronary5-10 or total5,7,11-13
mortality and has even been associated with longevity,10,14-17 and,
in Russia, with cardiovascular health.18 These findings have been
ignored or belittled as minor aberrations from the LDL receptor hypothesis, but
considering that more than 90 per cent of all cardiovascular disease occur in
people above age 60, it is in fact one of the most serious blows against it. Why
should we lower cholesterol if a high cholesterol is unimportant or beneficial?

It may be fruitful to search for a drug with the same effects on the
cardiovascular system as the statins but without influencing cholesterol
synthesis. In the meantime it seems worth while to test the lowest, effective
statin dose instead of trying to lower cholesterol as much as possible.


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Competing interests:  
None declared

Competing interests: No competing interests

06 October 2003
Uffe Ravnskov
Independent researcher
Magle Stora Kyrkogata 9, S-22350 Lund, Sweden