Effect of EPA/DHA on Coronary High-Intensity Plaques by Noncontrast T1-Weighted Imaging (AQUAMARINE)

The AQUAMARINE study used noncontrast T1-weighted cardiac MRI to detect “high-intensity plaques” — a marker of intraplaque hemorrhage or lipid-rich content — and randomized 84 statin-treated CAD patients to EPA/DHA or control to test whether omega-3 therapy modified these high-risk plaque features.

No significant difference was found in the plaque-to-myocardium signal intensity ratio (the primary imaging endpoint) or in CT-based high-risk features between groups over the treatment period. This null result on MRI plaque phenotype was accompanied by no significant clinical event difference.

The study is notable as a contrast to the EPA-only plaque stabilization data: combined EPA+DHA, which failed to reduce events in STRENGTH, also failed to modify high-risk plaque features by cardiac MRI in this small imaging trial. This is consistent with the hypothesis that DHA may attenuate EPA’s plaque-stabilizing effects — though the small sample and short duration prevent definitive conclusions.

We rate the evidence limited. A small imaging RCT producing a null result for combined EPA+DHA on coronary plaque phenotype — adding to the evidence that the EPA/DHA combination does not replicate the plaque effects seen with pure EPA in the JELIS and REDUCE-IT context.