<p>H-type hypertension, characterized by concomitant hypertension and hyperhomocysteinemia (HHcy), is associated with heightened cardiovascular risk. Despite emerging evidence implicating apolipoprotein A1 (APOA1) in atherosclerotic processes, its prognostic value in acute myocardial infarction (AMI) patients with H-type hypertension remains underexplored.We conducted multivariable-adjusted cox regression analyses to investigate major adverse cardiovascular events (MACES) associations. Non-linear relationships were explored using restricted cubic spline (RCS) and threshold effect analyses. Survival disparities were quantified through Kaplan-Meier estimates. Stratification analyses were used to demonstrate the stability of the relationship between APOA1 and MACES. A total of 581 participants were included, with a median follow-up time of 34.00 ± 1.21 months, and 134 MACES occurred, with higher tertiles of the APOA1 associated with a lower cumulative risk of MACEs (log-rank, P &lt; 0.001). After adjusting for confounders, the fully adjusted HRs (95% CI) for Q3 and Q4 of the APOA1, with the lowest tertile as reference, were 0.46 (0.23,0.92) and 0.42 (0.19,0.93), respectively. RCS analysis showed that APOA1 had a linear relationship with MACES. Subgroup analyses and interaction tests revealed that the association between APOA1 and MACES was negative association at most subgroup (Pinteraction &gt;0.05). However, with the negative association observed in participants with hs-CRP &gt; 3(mg/L), but not in those with hs-CRP ≤ 3(mg/L). In conclusion,emerging evidence demonstrates an inverse association between APOA1 and MACES risk in H-type hypertension with AMI.</p>