Fluvastatin, the first totally synthetic inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, has the unique structure of a mevalonolactone derivative of a fluorophenyl-substituted indole ring. Fluvastatin markedly reduces plasma lipid levels in animals and humans by inhibiting the activity of HMG-CoA reductase following the up-regulation of low density lipoprotein receptors, as it occurs with other HMG-CoA reductase inhibitors. Several lines of evidence indicate that the hypolipidemic action of fluvastatin results in antiatherosclerotic effects in hyperlipidemic animal models. Recent findings have shown, however, that fluvastatin inhibits the progression of atherosclerosis independent of its lipid-lowering effects. In addition, fluvastatin inhibits key events or factors in the initiation or progression of atherosclerosis. These effects include antioxidant and antithrombotic properties, improvement of endothelial function, inhibition of activated monocyte-endothelial cell interaction, and inhibition of activated macrophage and smooth muscle cell function. Recent large clinical trials with fluvastatin demonstrated its beneficial effects on the incidence of clinical events and on the progression of atherosclerotic plaques in patients with hyperlipidemia. Although angiographic changes (e.g., the decrease in minimum lumen diameter) in response to therapy were modest, the accompanying clinical benefit appeared to be significant. The lipid-lowering therapy can not fully explain the results of clinical trials. The antiatherogenic profiles of fluvastatin might contribute to the decrease in the clinical events by directly inhibiting the atherosclerotic plaque progression and stabilizing the atherosclerotic plaque lesion. Elucidation of pleiotropic effects of fluvastatin other than lipid-lowering properties encourages the clinical use of fluvastatin not only for the reduction of plasma cholesterol levels but also for the secondary prevention of coronary heart disease in patients with hypercholesterolemia.