EPA plus DHA Supplementation Retard Progression of Fibrous Coronary Artery Plaque in Subjects on Statins
Alfaddagh , A. et al., J. Amer. Heart Assoc., 6: in press, 2017
Division of Cardiology, Beth Israel Deaconess Medical Ctr., Harvard Medical School, Boston, Mass., USA
The central goal of the present clinical trial was to determine if EPA/DHA supplementation as provided for patients with coronary artery disease, who were taking blood cholesterol-lowering medication via statins, may favorably attenuate the progression of coronary plaques. For this purpose, 285 subjects (average age of 63 years) with stable coronary artery disease on statin therapy were either randomly assigned to receive 3.4 grams of EPA/DHA daily (1.9 grams EPA plus 1.5 grams DHA) or served as controls (no EPA/DHA supplementation). Coronary plaque volume was assessed by CCTA (coronary computed tomographic angiography) at entry and after a follow-up period of 30 months. A total of 240 subjects (126 in the omega-3 group and 114 in the control group) completed the study.
A significant difference was found ( in the median values) between the groups with respect to the % change from baseline at the 30-month interval (per-protocol analyses) with the control group showing a 5 % increase in fibrous plaque volume in contrast to no increase in the omega-3 group. Similar significant differences with respect to attenuation of fibrous plaque progression by EPA/DHA omega-3 supplementation were found also for those subjects receiving low-intensity statin therapy but not for those on high-intensity statin therapy. Over the 30-month interval, younger patients (median age of 63.7 years or below) but not older patients showed marked increases in the % volume changes for total, fibrous, and non-calcified plaque volumes of +10.1 %, +7.3 %, and +8.5 % , respectively, if in the control group in contrast to those in the EPA/DHA group who showed changes of +1.4 %, -3.2 %, and -5.1 %, respectively.
Dr. Holub's Comments:
The present results support the benefit of EPA/DHA omega-3 supplementation in retarding coronary plaque progression in patients with coronary artery disease receiving blood cholesterol-lowering treatment with statins. The benefit of omega-3 supplementation was related to particular sub-groups of patients (according to the degree of statin treatment and age). The results have potential clinical application since plaque volume predicts cardiovascular events. While the significant blood triglyceride-lowering with EPA/DHA of 14.3 % overall as found in the present study may contribute to the retardation of plaque progression, other effects including anti-inflammatory , anti-thrombotic, decreased adhesion of monocytes to the endothelium likely play key roles.