After that, HTG was efficiently controlled with high dosages of fibrates or a fibrate plus acipimox, except for the patient with H CM, who was on a specific diet (the only source of fat was a special oil consisting of medium chain triglyceride) and taking a high dosage of acipimox.
In some studies, mitochondria-associated pathway can be manipulated to extend lifespan by pharmacological drugs, such as antioxidant and SIRT1-activtor resveratrol , antilipolytic acipimox , and antidiabetic metformin .
In support of this suggestion, reductions in plasma FFA through treatment with acipimox have been shown to decrease fat oxidation, increase carbohydrate oxidation, and lower blood glucose during moderate intensity exercise in T2D patients .
This possibility is further suggested by the observation that aerobic exercise produced similar reductions in postprandial lipemia in the presence or absence of pharmacological inhibition of adipose tissue lipolysis by acipimox .
On the other hand, decreasing plasma FFA concentration by administration of acipimox, a nicotinic acid analogue that inhibits adipose tissue lipolysis, rapidly improves muscle insulin sensitivity .
Whatever the precise pathophysiological mechanism, it has been shown that lowering fatty acid availability by suppressing 24 h FFA levels, using short term intensive treatment with the nicotinic acid analog acipimox, induced substantial improvements in blood glucose control in patients with type 2 diabetes .
(34) The data of Sekhar et al (20,21) would suggest that the source of the fat that accumulates in the liver is from excessive lipolysis; indeed Hadigan et al showed that blocking lipolysis acutely with acipimox improved insulin sensitivity in patients with HIV-associated lipodystrophy and visceral obesity.