EPA and DHA Supplementation and Coronary Artery Calcium Progression in Patients With CAD

This trial tested whether omega-3 supplements (EPA plus DHA) slow the buildup of coronary calcium in patients with established coronary disease on statins.

The answer was no. Despite lowering triglycerides, EPA plus DHA did not significantly reduce coronary calcium progression compared with control — and this held regardless of baseline calcium, statin intensity, or how high omega-3 blood levels rose. A clean negative for this particular endpoint and formulation.

The result is worth pairing with the same group’s earlier, more favorable finding on soft (fibrous) plaque (Alfaddagh 2017). Calcium is only one feature of plaque, and progression of calcium can even reflect stabilization rather than worsening — so a null effect on calcium does not fully settle whether omega-3s affect plaque biology. Still, it tempers enthusiasm for combined EPA/DHA products, which differ from the purified high-dose EPA that succeeded in REDUCE-IT.

We rate the evidence moderate. As a randomized secondary analysis it is reasonably sound; its negative result on calcium adds to the mixed, generally underwhelming evidence for mixed omega-3 supplements.