#45 Statins: Prescribing Meds Day vs. Night Part 2 Mind the Gap Segment

Core IM | Internal Medicine Podcast

Core IM Team

Mental Health, Education, Health & Fitness, Medicine

4.8 • 1K Ratings

🗓️ 24 July 2019

⏱️ 15 minutes

🔗️ Recording | iTunes | RSS

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Summary

Night and Day… join us for part II of our exploration into why we prescribe medications in the morning vs. at night, featuring statins! 03:28 How do statins and cholesterol synthesis work again, anyway? 04:00 Power in numbers - what do the meta-analyses say about timing of statins? 04:40 The long and short of it - how half-life may dictate when to take your statin. 07:35 Effect magnitude - does medication timing actually really impact patient outcomes? 10:30 Practical matters - so what should we tell patients? 11:05 Review of teaching points Show notes, transcripts and references (https://www.coreimpodcast.com/2019/07/24/statins-prescribing-meds-day-vs-night-part-2/) Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

Transcript

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0:00.0	Welcome back. Last time we talked about why it might be better to take blood pressure meds at night.
0:05.8	But one thing some listeners noted was that we didn't really address which medications to switch.
0:11.0	Actually I think we were kind of hoping you guys wouldn't notice because we weren't all
0:15.2	that show ourselves, but good for you for catching that.
0:18.3	So we were chatting with our reviewer, Dr. Matthew Sparks.
0:21.4	And he had some interesting personal anecdotes to share.
0:23.9	For starters, he brought us back to reality. Yeah, so the research studies we referenced
0:28.8	used ambulatory blood pressure monitors to diagnose blood pressure dips or non-dips at night.
0:34.0	But the thing is nobody does that in the real world.
0:36.0	Yeah, some of that has to do with insurance.
0:38.0	It turns out most insurances don't cover ambulatory blood pressure monitoring
0:42.0	unless you're trying to diagnose white coat hypertension,
0:44.8	a totally different problem.
0:46.1	In a way, that's a pretty good gamble on their part.
0:48.2	I'm not so sure my ego could handle prescribing a test
0:51.1	just to see if my patients are actually afraid of me.
0:53.0	Well, Steve, they probably are.
0:55.0	But in all seriousness, we ask Dr. Sparks what he does in real life
0:59.0	because he can't just pretend that all patients have white coat hypertension
1:02.0	to get their
1:02.7	insurances to pay for ambulatory blood pressure cuffs.
1:05.0	Because that would be insurance fraud.
	...

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