TOPLINE:

Adding alpha-lipoic acid to standard therapy in patients with ischemic heart failure (IHF) was associated with clinical event rates and safety comparable with placebo but modestly higher left ventricular ejection fraction (LVEF) and 6-minute walking distance over a 24-month follow-up period, according to a brief report published in JACC: Heart Failure.

METHODOLOGY:

• Researchers conducted a double-blind randomized study to assess the efficacy of adding alpha‑lipoic acid to standard medical therapy in patients with IHF.
• They enrolled adults with a prior myocardial infarction (> 30 days before enrollment) and chronic HF with LVEF ≤ 50% at multiple centers in China between January 2019 and January 2023.
• Patients were randomly assigned to receive either 600 mg of alpha-lipoic acid or a matching placebo daily for 24 months. The final analysis included 277 patients: 138 in the alpha-lipoic acid group and 139 in the placebo group.
• The primary outcome was time to the first occurrence of a composite of hospitalization for HF and all-cause mortality. Secondary outcomes included hospitalization for HF, all-cause mortality, nonfatal myocardial infarction, and nonfatal stroke. Changes in LVEF and 6-minute walk distance were also assessed.
• Researchers measured outcomes at baseline, 12 months, and 24 months and analyzed outcomes over the 24‑month treatment and follow‑up period.

TAKEAWAY:

• The primary outcome occurred in 23.2% of patients in the alpha-lipoic acid group and 28.8% in the placebo group, with no statistically significant difference between the two groups (hazard ratio [HR], 0.753; P = .231).
• The composite of major adverse cardiovascular events occurred in 25.4% of patients in the alpha-lipoic acid group and 33.8% in the placebo group, with no statistically significant difference observed (HR, 0.685; P = .091).
• At 24 months, the alpha-lipoic acid group showed an estimated 3.20% increase in LVEF (P = .002) and a 31.7-m improvement in 6-minute walk distance (P = .008) compared with the placebo group.
• Subgroup analyses suggested larger effects in patients not on triple therapy and in men; however, the interaction by sex was not statistically significant (P for interaction = .144). Adverse event rates were similar between the groups.

IN PRACTICE:

“An absolute increase of 3.2% in LVEF cannot serve as direct evidence for the clinical efficacy of ALA [alpha-lipoic acid] in IHF, given its small magnitude of change, which may also be the result of interobserver variability,” the researchers wrote.

“This study suggests a potential for ALA as a treatment for ischemic HF, but these results need to be further validated in larger, adequately powered, multicenter trials in broader populations,” they added.

SOURCE:

The study was led by Hanchuan Chen, MD, Fudan University, Shanghai Institute of Cardiovascular Diseases in Shanghai, China. It was published online on January 9, 2026, as a brief report in JACC: Heart Failure.

LIMITATIONS:

The small sample size was insufficient to reliably detect differences in the primary outcome. The enrollment of only Chinese participants limited the generalizability of the findings to other populations.

DISCLOSURES:

The study drug was provided by Jiangsu Wahoo Pharmaceutical Co. One author reported receiving grants from the Clinical Research Fund of Zhongshan Hospital, the Key Project of the National Natural Science Foundation of China, the Basic Research Projects of the Shanghai Science and Technology Commission, and the Innovation Program of the Shanghai Municipal Education Commission. All other authors reported having no relevant disclosures. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.