EPA Versus Mixed EPA/DHA Plus Statin for Coronary Atherosclerosis
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A broad literature examining effects of EPA vs EPA/DHA at molecular, cellular, imaging, and clinical endpoint levels suggests more robust benefit with purified EPA rather than mixed EPA/DHA.
“a broad literature examining effects of EPA vs EPA/DHA at the molecular and cellular levels,39, 40, 41, 42 their effects at the level of atherosclerotic plaque quantifiable with clinical imaging,8 and their effects at the clinical endpoint level evidenced in the RCT literature reviewed here, all suggest more robust benefit with purified EPA rather than mixed EPA/DHA.”
From Effects of Eicosapentaenoic Acid vs Eicosapentaenoic/Docosahexaenoic Acids on Cardiovascular Mortality (2025) · cites this paper as [8]
The questions of efficacy and whether differences in study populations, drug formulations, and placebo arms may explain discrepant results of high-profile trials have been debated.
“The questions of efficacy and whether differences in study populations, drug formulations, and placebo arms may explain discrepant results of high-profile trials have been debated.7,8”
From Effects of Eicosapentaenoic Acid vs Eicosapentaenoic/Docosahexaenoic Acids on Cardiovascular Mortality (2025) · cites this paper as [8]
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Cites
Nishio, R., Shinke, T., Otake, H., Nakagawa, M., Nagoshi, R., Inoue, T., Kozuki, A., Hariki, H., Osue, T., Taniguchi, Y., et al. (2014) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2014.02.025 · Cited by 133 · see citing works
Omega-3 Benefits Remain Strong Post-STRENGTH
Bernasconi, A. A., Lavie, C. J., Milani, R. V., & Laukkanen, J. A. (2021) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2021.03.004 · Cited by 37 · see citing works
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Research works printed but not linked: 12
- Khan SU, Bhatt DL. Meta-analysis of contemporary trials of omega-3 fatty acids containing both eicosapentaenoic and docosahexaenoic acids. EClinicalMedicine. 2021;39:101110. https://doi.org/10.1016/j.eclinm.2021. 101110 · DOI
- Nelson JR, Wani O, May HT, Budoff M. Potential benefits of eicosa- pentaenoic acid on atherosclerotic plaques. Vascul Pharmacol. 2017;91:1-9.
- Tsunoda F, Lamon-Fava S, Asztalos BF, Iyer LK, Richardson K, Schaefer EJ. Effects of oral eicosapentaenoic acid versus docosahexaenoic acid on human peripheral blood mononuclear cell gene expression. Atherosclerosis. 2015;241: 400-408.
- Pal A, Metherel AH, Fiabane L, Buddenbaum N, Bazinet RP, Shaikh SR. Do eicosapentaenoic acid and docosahexaenoic acid have the potential to compete against each other? Nutrients. 2020;12(12):3718. https://doi.org/10. 3390/nu12123718 · DOI
- Budoff MJ, Bhatt DL, Kinninger A, et al. Effect of icosapent ethyl on pro- gression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy: final results of the EVAPORATE trial. Eur Heart J. 2020;41: 3925-3932.
- Alfaddagh A, Elajami TK, Ashfaque H, Saleh M, Bistrian BR, Welty FK. Effect of eicosapentaenoic and docosahexaenoic acids added to statin therapy on coronary artery plaque in patients with coronary artery disease: a randomized clinical trial. J Am Heart Assoc. 2017;6(12):e006981. https://doi.org/10.1161/ JAHA.117.006981 · DOI
- Watanabe T, Ando K, Daidoji H, et al. A randomized controlled trial of eicosapentaenoic acid in patients with coronary heart disease on statins. J Cardiol. 2017;70:537-544.
- Niki T, Wakatsuki T, Yamaguchi K, et al. Effects of the addition of eico- sapentaenoic acid to strong statin therapy on inflammatory cytokines and coronary plaque components assessed by integrated backscatter intravascular ultrasound. Circ J. 2016;80:450-460.
- Wakita Y, Wakida Y, Itou T, Mizuno R. Abstract 8893: high purity eicosa- pentaenoic acid in addition to a strong statin makes regression of coronary plaque in patients with angina pectoris. 2011 conference of the American Heart Association. Boston, MA. Circulation. 2011:A8893.
- Ahn J, Park SK, Park TS, et al. Effect of n-3 polyunsaturated fatty acids on regression of coronary atherosclerosis in statin treated patients undergoing percutaneous coronary intervention. Korean Circ J. 2016;46:481-489.
- Sugizaki Y, Otake H, Kuroda K, et al. Concomitant use of rosuvastatin and eicosapentaenoic acid significantly prevents native coronary atherosclerotic progression in patients with in-stent neoatherosclerosis. Circ J. 2020;84: 1826-1836.
- Kita Y, Watanabe M, Kamon D, et al. Effects of fatty acid therapy in addition to strong statin on coronary plaques in acute coronary syndrome: an optical coherence tomography study. J Am Heart Assoc. 2020;9:e015593.
Cited by
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Sheppard, J. P., Palatnic, L., Lakshmanan, S., Drago, T., Bhogal, J., Roy, S. K., Bhatt, D. L., Budoff, M. J., & Nelson, J. R. (2025) · JACC: Advances · doi:10.1016/j.jacadv.2025.102149 · Cited by 3 · see citing works
Self-citation
- Authors
- Sheppard, J. P., Lakshmanan, S., Dahal, S., Roy, S. K., Bhatt, D. L., Budoff, M. J., & Nelson, J. R.
- Affiliations
- The Lundquist Institute (US)
- Corresponding author
- Budoff, Matthew J.
- ORCID
- Venue
- JACC: Cardiovascular Imaging
- Publisher
- Elsevier BV
- Published
- 2022-10
- Volume
- 15
- Issue
- 10
- Pages
- 1825-1828
- ISSN
- 1876-7591 (ISSN-L)
- 1936-878X
- OpenAlex
- W4282965167
- Cited by
- 7
- References
- 2
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 2 · 2022: 1
- FWCI
- 0.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- JACC. Cardiovascular imaging (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Heart Association
- Bristol-Myers Squibb
- Sanofi
- CSL Behring
- Belvoir Media Group
- National Heart, Lung, and Blood Institute (T32HL149645)
- Duke Clinical Research Institute
- Daiichi Sankyo Europe
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Paraoxonase enzyme and polymorphisms
- Keywords
- EPA, docosahexaenoic acid, statins, coronary artery disease, omega-3 supplementation, lipid-lowering therapy
- MeSH terms
- Coronary Artery Disease, Humans, Predictive Value of Tests, Prospective Studies, Hydroxymethylglutaryl-CoA Reductase Inhibitors
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