Clinical reviews of fluvastatin: Short‐term and long‐term data

Fluvastatin is the newest available 3‐hydroxy‐3‐methylglutaryl‐coenzyme A (HMG‐CoA) reductase inhibitor. Double‐blind, controlled trials have indicated that fluvastatin, in dosages of 20 to 40 mg/day, lowers low‐density lipoprotein cholesterol (LDL‐C) levels by 19‐25%, increases high‐density lipoprotein cholesterol (HDL‐C) levels by 4.2‐7.8%, decreases triglyceride (TG) levels by 8.1‐10.4%, and reduces apo B levels by 12.3‐16.4% in parallel with the fall in LDL‐C. In one study, low‐dose fluvastatin combined with niacin produced a 40% drop in LDL‐C levels without untoward adverse events, suggesting that the combination may be safe and effective in patients who require intensive lipid‐lowering therapy. Long‐term safety of the combination, however, has yet to be determined. Results from a titrate‐to‐goal study have demonstrated that the favorable effects of fluvastatin on lipid profile are sustained over a long‐term (96‐week) period. The tolerability profile of fluvastatin has been shown to be similar to that of placebo, and, to date, no cases of myopathy or rhabdomyolysis have been reported with the new agent. The incidence of asymptomatic, reversible rises in hepatic transaminase levels with fluvastatin is comparable to that reported with other HMG‐CoA reductase inhibitors, but such increases tend to be limited to the first 3 months of fluvastatin therapy. The cost of producing the 20‐25% reduction in LDL‐C levels required in most patients with hypercholesterolemia is some 40% less with fluvastatin than with other members of its class. Thus, of the HMG‐CoA reductase inhibitors currently available, fluvastatin provides the most cost‐effective means of achieving goal LDL‐C levels and commensurate cardiovascular risk reduction in patients with mild to moderate type II primary hyperlipidemia.