In the case of statins, prescribers have a host of medications to choose from: atorvastatin (Lipitor),pravastatin (Pravachol) andsimvastatin (Zocor), just to name a few. All treat high cholesterol but differ in many other regards – their active ingredient, interactions, potency, cost and side effects. These differences help allow doctors to match prescription to patient needs – but they alone don’t explain which statin any given patient is prescribed.
Different doctor, different statin
Does a cardiologist prescribe your statin, or does a primary care provider? Depending on your doctor’s specialty, you may be more likely to be prescribed one statin over another.
According to a sample of Medicare Part D claims from 2016, cardiologists prescribe 12% more atorvastatin, 5% more rosuvastatin and nearly 12% less simvastatin than primary care doctors.
Primary care providers (PCPs) treat a wide range of diseases, and patients tend to stick with their PCP for many years. Simvastatin, which is one of the oldest generic statins available, is prescribed significantly more frequently by primary care providers than by cardiologists. It’s possible that PCPs are more reluctant to switch their patients’ statin if it’s working and continue them on simvastatin as it has been around for years.
On the other hand, patients typically see cardiologists when they need a specialist to diagnose or treat their heart disease or high cholesterol. Since cardiologists are likely more up to date on the latest cardiology research than primary care doctors, it’s possible that they are more inclined to prescribe a statin that is best at lowering cholesterol, which many consider to be rosuvastatin.
Location, location, location
Location also matters. In the case of atorvastatin, patients in Pacific states (CA, OR, WA) fill 6.2% more atorvastatin than the national average, whereas patients in east south central states (MS, AL, TN) fill 3.7% less atorvastatin. Pravastatin, generic Pravachol, is filled highest in southern states, with states in the east south central region filling 5.8% more pravastatin than the national average.
What accounts for these geographical variations? It’s not clear, but a couple of factors could be at play here.
Bias in your area towards one statin over the other could be a factor. In other words, if a majority of doctors in a state are prescribing one particular statin, others may follow suit. This could be the case for lovastatin in Pacific areas. As one of the least filled statins, lovastatin has few benefits over the others, but in Pacific states, more patients are taking it over rosuvastatin and simvastatin.
Pharmacological differences could also be at play here. Rosuvastatin is one of the best statins for people with diabetes, so it’s reasonable that fills for rosuvastatin are higher in regions with high rates of diabetes, like the south. Similarly, lovastatin is best for patients with liver problems, and fills are highest in southern regions that tend to have higher rates of liver disease and cirrhosis of the liver.
Luckily, there isn’t a vast difference between statins. Yes, rosuvastatin is the best for lowering bad cholesterol, and simvastatin has more interactions with other drugs, but in general, most people won’t notice a difference between one statin over the other. So, if you suspect you’re taking simvastatin because you see a primary care provider, or pravastatin because you live in the south, don’t panic. If it’s working for you, you’re probably on the correct statin.
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Methodology: Data comes from the 2016 Centers for Medicare and Medicaid Services (CMS) report on nationwide prescription volume. Regions in the analysis are based on census divisions from the US Census Bureau:
Pacific: CA, OR, WA, AK, HI
Mountain: AZ, NM, NV, UT, CO, ID, WY, MT
West North Central: ND, SD, NE, KS, MO, IA, MN
West South Central: OK, AR, TX, LA
East North Central: WI, MI, IL, IN, OH
East South Central: KY, TN, MS, AL
New England: ME, VT, NH, MA, CT, RI
Middle Atlantic: NY, PA, NJ
South Atlantic: DC, MD, DE, WV, VA, NC, SC, GA, FL
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