Key result
Adding acipimox to statin therapy is linked to ~32% lower 1-year MACCE in post-AMI hypertriglyceridemia.
Why the study?
Does adding acipimox to statin therapy reduce 1-year MACCE and NACE in AMI patients with hypertriglyceridemia?
Cohort (n=38,190)
Yes
Does adding acipimox to statin therapy reduce 1-year MACCE and NACE in AMI patients with hypertriglyceridemia?
In a real-world cohort of AMI patients with hypertriglyceridemia, adding acipimox to statin therapy was associated with a significantly reduced 1-year risk of major adverse cardiovascular events and improved lipid profiles.
May support adjunctive acipimox in hypertriglyceridemic AMI; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Residual cardiovascular risk persists in patients with acute myocardial infarction (AMI) and hypertriglyceridaemia despite statin therapy. The potential benefit of acipimox, a niacin derivative, as an adjunct to statins in this context remains uncertain. This study evaluated the association between statin-acipimox combination therapy and cardiovascular outcomes in AMI patients with elevated triglyceride levels. METHODS: We conducted a retrospective cohort study using the Tianjin Coronary Artery Disease Specialised Database (2010-2024). First-time AMI patients with triglycerides ≥ 1.7 mmol/L who received statins were included. Patients treated with statins plus acipimox were compared with those receiving statin monotherapy. The primary outcomes were 1-year major adverse cardiovascular and cerebrovascular events (MACCE) and net adverse clinical events (NACE). Associations were first evaluated in the original unmatched cohort and then in a 1:1 propensity score-matched cohort. Subgroup analyses were prespecified. Sensitivity analyses included progressively adjusted Cox models, IPTW-adjusted repetitions, adherence-stratified analyses, and Fine-Gray competing risk models. RESULTS: Among 38,190 eligible AMI patients with hypertriglyceridaemia, 624 received acipimox in addition to statins. In the original unmatched cohort, combination therapy was associated with lower 1-year risks of MACCE (adjusted hazard ratio [aHR] 0.66, 95% confidence interval [CI] 0.49-0.87) and NACE (aHR 0.64, 95% CI 0.52-0.79), with no significant differences in all-cause or cardiac mortality. After 1:1 propensity score matching (596 pairs), these benefits persisted (MACCE: aHR 0.68, 95% CI 0.51-0.90; NACE: aHR 0.64, 95% CI 0.48-0.84), again without a mortality difference. Secondary analyses demonstrated larger reductions in triglycerides, LDL-C and VLDL-C and greater increases in HDL-C with combination therapy. Subgroup analyses showed generally consistent protective associations across most clinical strata. Subgroup findings were generally consistent across most strata. Results remained robust across all sensitivity analyses. CONCLUSIONS: In this real-world cohort, adding acipimox to statin therapy was associated with improved cardiovascular outcomes in AMI patients with hypertriglyceridaemia, accompanied by a favourable downward trend in triglyceride-related lipid measures.
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Gu et al. (2026) conducted a cohort in Acute myocardial infarction with hypertriglyceridemia (n=38,190). Acipimox plus statin therapy vs. Statin monotherapy was evaluated on 1-year major adverse cardiovascular and cerebrovascular events (MACCE) (aHR 0.68, 95% CI 0.51-0.90, p=0.007). Adding acipimox to statin therapy was associated with a significantly lower 1-year risk of major adverse cardiovascular and cerebrovascular events (aHR 0.68) compared to statin monotherapy in AMI patients with hypertriglyceridemia.
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