Outcome monitoring of fluvastatin in a Department of Veterans Affairs lipid clinic.
The aggressive lipid-lowering goals recommended by the second Adult Treatment Panel (ATP II) have created an increasing demand for treatment with 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors. Fluvastatin is the first completely synthetic agent in this class and offers a considerable price advantage over the other HMG-CoA therapies. In May 1994, the Buffalo Veterans Affairs Medical Center Lipid Clinic adopted a fluvastatin-preferred program in which all patients who were recommended for an HMG-CoA reductase inhibitor would be treated with fluvastatin as a first-line agent. Fluvastatin was started at 20 mg daily and titrated to goal. Patients who were stable with other HMG-CoA reductase inhibitors were converted to fluvastatin as just described. Preliminary analysis shows that, for new patients, 20 mg of fluvastatin daily at bedtime reduced low density lipoprotein cholesterol (LDL-C) by an average of 22% (range, 5-32%). Preliminary results for patients converted from another HMG-CoA reductase inhibitor showed that fluvastatin produced an additional LDL-C reduction of 18% (range, 5-30%). With a daily dose of 20 mg fluvastatin, patients with no heart disease (primary prevention) achieved ATP II goals in 60% of cases. For patients with established heart disease (secondary prevention), the goals of ATP II are lower but, despite this, 30% of patients taking fluvastatin at 20 mg daily achieved these goals. The patients in both groups who failed to achieve ATP II goals were titrated to a 40 mg daily dose, but the results of this titration are not yet available. Pharmacoeconomic outcomes were favorable.(ABSTRACT TRUNCATED AT 250 WORDS)
Kellick
K A
KA
Veterans Affairs Medical Center, Buffalo, New York 14215, USA.
Burns
K
K
McAndrew
E
E
Haberl
E
E
Hook
N
N
Ellis
A
A
D000328:Adult; D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D008078:Cholesterol, LDL / Q000097:blood; D003327:Coronary Disease / Q000517:prevention & control; D017046:Cost Savings; D016527:Drug Costs; D016903:Drug Monitoring; D005229:Fatty Acids, Monounsaturated / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000077340:Fluvastatin; D006787:Hospitals, Veterans; D006801:Humans; D006903:Hydroxymethylglutaryl CoA Reductases / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D006937:Hypercholesterolemia / Q000097:blood / Q000188:drug therapy*; D007211:Indoles / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D008148:Lovastatin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D009518:New York; D011322:Primary Prevention; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D005229:Fatty Acids, Monounsaturated; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007211:Indoles; D000077340:Fluvastatin; D008148:Lovastatin; D006903:Hydroxymethylglutaryl CoA Reductases