Higher epicardial adipose tissue volume is associated with higher coronary fatty plaque volume and is regulated by waist circumference but not EPA+DHA supplementation

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplementation lower triglyceride levels. The impact on epicardial adipose tissue volume (EATV), which is associated with cardiovascular events, is unclear. To determine if triglyceride reduction with EPA+DHA supplementation decreases EATV and whether EATV affects coronary plaque. 139 subjects with coronary artery disease on statins were randomized to 3.36 g EPA+DHA daily or none (control) for 30 months. EATV, coronary plaque volumes and coronary artery calcium score were measured with coronary computed tomographic angiography. Change in triglyceride level correlated with change in EATV (=0.47; =0.01). Despite a 6.7% triglyceride reduction (=0.021) with EPA+DHA supplementation compared to no change in control (between group =0.034); both groups had similar reductions in EATV possibly due to statin treatment. EATV above the median (>115.6 cm) was the only determinant of baseline coronary fatty plaque volume (β=2.4, =0.010). After multivariate adjustment, waist circumference, a surrogate of abdominal visceral adiposity, was the only determinant of baseline EATV (OR:1.093; 95% CI:1.003-1.192, =0.042). Moreover, increase in waist circumference was the only predictor of an increase in EATV at 30 months (β=0.320, =0.018). EATV is associated with higher coronary fatty plaque volume and is regulated by waist circumference but not EPA+DHA supplementation at 30-month follow-up in CAD patients on statin treatment. The direct correlation between waist circumference and EATV suggests that maintaining a healthy weight may limit EATV and coronary fatty plaque volume, potentially leading to a decrease in cardiovascular events.