Effects of purified eicosapentaenoic acid versus mixed eicosapentaenoic/docosahexaenoic acid pharmacotherapies on coronary plaque volume: network meta-analysis of prospective coronary imaging trials

Reduced cardiovascular event risk is observed with eicosapentaenoic acid (EPA), but EPA mixed with docosahexaenoic acid (EPA/DHA) does not show consistent benefit. Comparative effects of EPA versus EPA/DHA on coronary plaque remain unclear. We systematically reviewed trials measuring coronary plaque volume in patients randomised to statin + EPA or statin + EPA/DHA therapy compared to statin monotherapy, and used network meta-analysis to compare percent change in total and lipid coronary plaque volumes on these treatments. Among 553 articles, ten trials comprising 860 patients met inclusion criteria. Among statin, statin + EPA, and statin + EPA/DHA respectively, random effects analysis yielded changes of +1.9% [–3.4%, +7.2%], −10.0% [–17.5%, −2.5%], and −3.3% [–14.2%, +7.5%] in total plaque volume and +1.3% [–4.7%, +7.4%], −21.5% [–32.1%, −10.8%], and −6.1% [–18.9%, +6.7%] in lipid volume. Compared with statin, statin + EPA achieved greater percent reduction in coronary plaque volumes (total volume: SMD = 0.60, p p = 0.0017) but statin + EPA/DHA showed no difference (total volume: SMD = 0.19, p = 0.19; lipid volume: SMD = 0.43, p = 0.38). EPA but not EPA/DHA is associated with reductions in coronary plaque burden when given as adjunct to statins in patients with coronary artery disease. Across published trials, eicosapentaenoic acid (EPA) is associated with reduced total and lipid coronary plaque volume when administered as adjunct to statins in patients with coronary atherosclerosis.Mixed eicosapentaenoic acid/docosahexaenoic acid (EPA/DHA) is not associated with reductions in coronary plaque volume.Adjunctive EPA but not EPA/DHA is superior to statin monotherapy in terms of relative reduction in total and lipid coronary plaque volume. Across published trials, eicosapentaenoic acid (EPA) is associated with reduced total and lipid coronary plaque volume when administered as adjunct to statins in patients with coronary atherosclerosis. Mixed eicosapentaenoic acid/docosahexaenoic acid (EPA/DHA) is not associated with reductions in coronary plaque volume. Adjunctive EPA but not EPA/DHA is superior to statin monotherapy in terms of relative reduction in total and lipid coronary plaque volume.