Statins: Why this medication? I tried thinking about it without asking

Why was this particular statin chosen for my prescription?
I tried to deduce the doctor's reasoning while reading the prescription from a pharmacist's perspective.

The question I didn't ask
I recently wrote about starting cholesterol medication.
I was prescribed a drug called pitavastatin.
After about a month, my levels dropped properly, and I am satisfied with the results.
However, as a pharmacist, there was something that really bothered me.
That is, why this specific medication?
There are many types of cholesterol-lowering drugs, known as statins.
They don't all work the same way; each has slightly different characteristics.
Why was this one chosen from among them?
It's something I could find out in a second if I asked the doctor, but I decided to try thinking about it without asking.
How much of a doctor's reasoning can be read from a single sheet of paper called a prescription?
For a pharmacist, this is a bit of an intellectual game.

First, what gets ruled out
Medications have pathways they follow when being broken down in the body.
If these pathways are congested, they can clash with other drugs or foods.
This is why some drugs come with instructions not to take them with grapefruit juice.
Some statins also use these congested pathways.
I take other medications as well, and since this is a long-term treatment, I would prefer one that is less likely to clash.
Thinking about it that way, the candidates narrow down to a few.
Statins come in varying strengths.
I believe the doctor thought to start with a potent statin at a low dose.
Up to this point, I had a guess right away.
However, I hit a dead end here.
Pitavastatin is not the only drug that meets those criteria.
Another drug, rosuvastatin, also meets the same criteria.
And if anything, that one is stronger at lowering levels.

The one remaining difference
So, what separates these two?
While thinking about it, blood sugar came to mind.
In fact, statins have a tendency to raise blood sugar.
Because of this, it is known that they slightly increase the onset of diabetes.
Although it is a very small difference, it is a documented fact.
However, the situation is slightly different with pitavastatin.
It is a drug with fewer negative effects on blood sugar, and there are even reports of positive data.
Studies conducted in Japan have shown this tendency in patients prone to developing diabetes.
And the doctor who prescribed this to me was a diabetes specialist.
At this point, I felt the dots connect.
The doctor likely took blood sugar into consideration.
Lowering cholesterol while not wanting to disrupt blood sugar levels.
My guess is that this was chosen as the drug that satisfies both.
It is just my imagination, but it makes sense when you think about it that way.

Even specialists differ
What is interesting is what comes next.
I used to work at a pharmacy with many diabetic patients.
The doctor there, despite also being a diabetes specialist, often prescribed rosuvastatin.
At first glance, it seems like the exact opposite.
But when you think about it, it is not a contradiction.
For those who have already developed diabetes, the worry about whether they will develop it in the future is no longer relevant.
Rather, since people with diabetes are more prone to arteriosclerosis, it is more important to lower levels effectively.
If that is the case, choosing a drug with stronger lowering power makes sense.
In other words, if the patient's condition is different, the chosen drug changes.
Neither doctor is wrong.
Even among specialists, the answer changes depending on the person in front of them.
I think that is the interesting thing about medicine.

A prescription is like a letter
I will add this just in case.
Even if statins increase the risk of diabetes, the difference is very small.
It is known that the effect of preventing heart attacks and the like is far greater.
Therefore, there is absolutely no need to fear the medication for this reason.
This is just a story about careful consideration—choosing this one if it works just as well.
And in truth, I don't know if my deduction is correct.
The doctor might have had a different idea.
I am debating whether I should ask next time I have a checkup or just wait and see for a while longer.
A prescription only lists the drug name, dosage, and administration.
But behind that one line, there is often hidden how the doctor views that person and what they were trying to protect.
I thought that deciphering that is also a pharmacist's job.
If you have any concerns about your own medication, please feel free to ask your pharmacist.
They should be able to think through the meaning behind that line with you.

Summary
・Statins have slightly different actions and characteristics for each type
・When choosing a drug, not only cholesterol but also the effect on blood sugar may be considered
・Even among specialists, the chosen drug changes depending on the patient's condition
・Prescriptions often contain the doctor's treatment policy and intentions
・It is important to consult your doctor or pharmacist without hesitation if you have any questions about your medication