Bezpečnost a účinnost fluvastatinu po transplantaci srdce

Cor Vasa 2004, 45(10):475-477

The safety and efficacy of fluvastatin following heart transplantation

Lenka Hošková^*, Mariana Podzimková, Ivan Málek: Klinika kardiologie, Institut klinické a experimentální medicíny, Praha, Česká republika

Introduction:
Lipid metabolism disorders occur in 60-80% of patients under heart transplantation. The causes are multifactorial, with contributing factors being the use of immunosuppressives, particularly cyclosporin A and corticosteroids. Statin therapy is appropriate ever since the early postoperative period. The aim of our study was to evaluate the safety and efficacy of fluvastatin 80 mg over a six-month follow-up period.

Method:
Our group of patients included 40 patients an average 4 years post-transplant (0.9-8 years); they were 31 men and 9 women. The underlying disease prior to transplantation was dilated cardiomyopathy in 55% and coronary heart disease in 45% of patients. Prior to therapy initiation, all patients were taking a lipid-lowering drug, most often pravastatin (62.5%) and fluvastatin (27.5%). Fluvastatin 80 mg was given to patients with total cholesterol levels on pravastatin 40 mg or fluvastatin 40 mg per day was ³ 6 mmol/L and LDL-cholesterol ³ 3.4 mmol/L. All patients were on standard immunosuppressive therapy.

Results:
At 7 months, therapy with fluvastatin 80 mg led to a significant decrease in total cholesterol by 17.7% (7.08 ± 1.14 mmol/L vs. 5.78 ± 1.05 mmol/L, p < 0.001), LDL-cholesterol by 16.4% (4.09 ± 1.10 mmol/L vs. 3.31 ± 0.8 mmol/L, p < 0.001) and triglycerides by 22.7% (3.58 ± 2.43 mmol/L vs. 2.56 ± 1.36 mmol/L, p < 0.001). HDL-cholesterol levels rose by 26.3% (1.12 ± 0.45 mmol/L vs. 1.37 ± 0.57 mmol/L, p < 0.001). The mean levels of non-HDL-cholesterol improved significantly (p < 0.001).

Conclusion:
Lipid metabolism disorders are a frequent and important problem after heart transplantation; high doses of statins are necessary lipid metabolism normalization. Therapy with fluvastatin was associated with a decrease in LDL-
-cholesterol and an increase in HDL-cholesterol even in patients whose previous therapy failed to achieve control. The high dose of fluvastatin did not lead to myopathy even when combined with cyclosporin A.