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 < 0.0001; lipid volume: SMD = 1.1, 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.