Fluvastatin appears to protect people who have received kidney transplants from premature cardiovascular disease, according to an article published June 3rd in the online version of The Lancet. This patient group is known to be at high risk for early onset disease, in part due to the high prevalence of disease at time of transplant combined with postoperative risk for elevated cholesterol and hypertension (both of which can be aggravated by immunosuppressive therapy).

In an international multicenter study, Hallvard Holdaas, MD, and colleagues investigated the effects of fluvastatin use in roughly 2100 people (from European nations and Canada) who had previously undergone kidney transplantation. All participants had baseline cholesterol concentrations between 4 and 9 millimols/L. Half were randomized to fluvastatin, while the other half received placebo.

Follow-up was 5 to 6 years later. The primary endpoint was the occurrence of a major adverse cardiac event, defined as cardiac death, nonfatal myocardial infarction, or need for a coronary intervention procedure. Secondary endpoints included individual cardiac events, combined cardiac death or nonfatal myocardial infarction, cerebrovascular events, non-cardiovascular death, and all-cause mortality.

Cholesterol concentrations were reduced by roughly one third in the fluvastatin patients compared with the patients in the placebo group. There were fewer cardiac deaths or nonfatal myocardial infarctions in the fluvastatin group than in the placebo group (70 and 104, respectively), although the overall difference in primary endpoints (including coronary intervention procedures) was not statistically significant for the two groups.

Holdaas commented, "As many as 50 percent of renal transplant recipients are now treated with statins, which reflects the widespread acceptance of data from other populations, particularly for the secondary prevention of cardiac disease and in diabetes. These other statin studies have shown that statins are effective in patients with mild renal failure who are at increased cardiovascular risk, some of whom may ultimately require renal transplantation. This study shows a similar beneficial effect for fluvastatin, a statin that has minimal interaction with immunosuppressive therapy, in patients at the opposite end of the spectrum of renal failure.