Combination therapy of statin and acipimox versus statin monotherapy in acute myocardial infarction with hypertriglyceridemia: a multicenter propensity score–matched analysis

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.