Safety and Efficacy of Statin-Based Acipimox Therapy in Patients With Acute Myocardial Infarction with Elevated Triglyceride Levels

초록

Background Elevated triglyceride levels are associated with an increased risk of acute myocardial infarction (AMI) and can affect the prognosis of patients post-AMI. Niacin medications, instrumental in managing triglycerides, exhibit a controversial profile in cardiovascular disease populations. There is a notable absence of research to guide the use of acipimox in AMI patients, indicating a significant research gap. The aim of this study was to address this deficiency by evaluating the safety and efficacy of adding acipimox to statin therapy in AMI patients with elevated triglyceride levels. Methods The data for this study were sourced from the Tianjin Coronary Artery Disease Specialized Database, comprising a retrospective cohort of patients registered across 82 hospitals in Tianjin City from January 1, 2010, and March 31, 2024, with discharge diagnoses of coronary artery disease. We included first-time AMI patients with serum triglyceride levels exceeding 1.7 mmol/L during hospitalization, all of whom were on statin therapy (n = 38,193). The primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE), with secondary outcomes comprising net adverse clinical events (NACE) and individual components of MACCE and NACE. MACCE is composed of cardiac death, recurrent myocardial infarction, follow-up ischemic stroke, and coronary revascularization. NACE, in addition to MACCE components, includes all-cause mortality and bleeding events classified as Bleeding Academic Research Consortium type 3 or higher. Propensity score matching (PSM) was used to adjust for differences in clinical characteristics between the 2 groups. Multivariable Cox regression was conducted before and after PSM to evaluate the impact of acipimox on outcomes. Results Within our study cohort, 625 individuals received a combination therapy with acipimox in addition to statins, whereas 37,568 individuals were treated with statin monotherapy. Compared with control group, those treated with a combination of statins plus acipimox exhibited significantly lower risks of 1-year MACCE (adjusted hazard ratio [aHR]: 0.68 [0.55-0.85]; P < 0.001), 1-year NACE (aHR: 0.72 [0.59-0.88]; P = 0.002) and 1-year revascularization events (aHR: 0.70 [0.52-0.93]; P = 0.017). However, no significant differences were observed in the incidence of other secondary outcomes. After PSM, the multivariable Cox regression analysis confirmed the consistent benefits in reducing MACCE and NACE, with no significant impact on revascularization events, but a significant protective effect on stroke (Figure 1). Following PSM, survival analysis revealed that the 1-year cumulative incidence rates of MACCE and NACE were markedly lower in patients administered a combination of statins and acipimox, as compared with statin monotherapy (Figure 2). Subgroup analyses uniformly revealed that the addition of acipimox to statin therapy provided a protective effect against 1-year MACCE and 1-year NACE, with the beneficial outcomes being consistent across both the ST-segment elevation myocardial infarction and non–ST-segment elevation myocardial infarction subtypes (P for interaction in MACCE: 0.25; P for interaction in NACE: 0.72), as well as among the various Killip class subgroups (P for interaction in MACCE: 0.40; P for interaction in NACE: 0.40). Conclusions The addition of acipimox to statin therapy demonstrates a significant reduction in the risk of MACCE and NACE within the first year when compared with statin monotherapy in AMI patients with elevated triglyceride levels.