Treatment of dyslipidaemias with fluvastatin

In many patients with primary hyperlipidaemia the statins have become the drugs of choice when diet alone has failed. The usual dosages of statins prescribed in most countries appear to be aimed at producing a reduction in levels of low-density lipoprotein cholesterol (LDL-C) of about 25%. Fluvastatin is the newest member of this class of agent and the first completely synthetic compound. In dose-finding studies, fluvastatin has produced statistically significant (P < 0.001) reductions in LDL-C levels when used in dosages of 20 mg (21%) and 40 mg (27.4%), thus placing it within the range generally expected with usual dosages of other statins; additional studies have shown that the efficacy of fluvastatin is unaffected by gender and age. Moreover, fluvastatin produces the maximum reduction in LDL-C levels within 6 weeks and maintains this efficacy during long-term treatment (LDL-C levels have been reported to fall by 27.4% over 2 years with fluvastatin 40 mg/day). In high-risk patients the LDL-C-lowering effect of fluvastatin 40 mg/day is maintained when compared with low-risk patients (26.6% vs 24.8%). A similar pattern has been observed in hypertensive patients, irrespective of the antihypertensive agent used to control blood pressure. Fluvastatin has been found to produce better LDL-C-lowering effects than bezafibrate. In addition to lowering LDL-C levels by the required amount, 20 and 40 mg (the equivalent of pravastatin 20 mg) dosages of fluvastatin significantly reduce levels of total cholesterol and triglycerides and increase high-density lipoprotein cholesterol levels.