Effect of EPA and DHA Added to Statin Therapy on Coronary Artery Plaque in Patients With CAD

Fish-oil omega-3s are among the most-taken supplements in cardiology, and among the most contested. This trial asked a concrete question: added to a statin, do high-dose EPA and DHA actually slow the buildup of coronary plaque?

Over 30 months, the investigators used CT angiography to track plaque in stable coronary patients randomized to omega-3 ethyl esters or control. The supplement modestly slowed the progression of fibrous plaque, with the effect most visible in younger patients and in those on lower-intensity statins — that is, in the people with more room left to benefit.

The result lands in a genuinely murky area. It uses imaging change as a stand-in for clinical events, the effect was modest, and it concerns a combined EPA/DHA product, not the purified high-dose EPA that succeeded in the larger REDUCE-IT outcomes trial. It is suggestive, not decisive.

We rate the evidence strong for its design — a randomized, imaging-based trial — but its clinical significance is moderate. It nudges the omega-3 debate slightly toward “may help at the margins,” without settling the question that only a hard-outcomes trial can.