A case of borderline diabetic patient identified a quantitative regression and qualitative stability of isolated plaque by coronary CT angiography during purified eicosapentaenoic acid (EPA) administration

Background : A 51-year-old man presented with chest oppression at rest. He had been diagnosed as having borderline diabetes and hypertriglyceridemia. Investigations : Blood test, Double master stress ECG (stress ECG), transthoracic echocardiography (TTE), abdominal scan and coronary CT angiography (CTA) were performed according to his family doctor's proposal and his agreement. Diagnosis : The patient was diagnosed as having a metabolic syndrome without ischemia and coronary artery calcification but mild stenosis with "Positive remodeling" associated with an isolated large plaque burden in between first and second diagonal branches of left anterior descending coronary artery by CTA. Management : He was treated with ultra purified eicosapentaenoic acid (EPA : 1200 mg/ day), aspirin (100mg/day) and diet. At the 12-month follow-up appointment, hypertriglyceridemia and visceral fat were normalized, despite of the failure of diet. On coronary CT image, the new calcified and non calcified plaque was not identified on three major coronary arteries and their branches. The isolated plaque volume between two diagonal branches had 50% reduction (136 mm³) from the baseline (272 mm ³) and also the remodeling index (culprit vessel area ratio based on reference) was improved (1.8 to 1.2). The plaque was seemed to be stabilized or stabilizing according to the increased mean CT attenuation (46 to 52). Conclusions : Twelve months of follow-up has demonstrated that a patient was successfully treated with EPA tailored to reduce the plaque volume quantitatively and also to stabilize it qualitatively, although the large investigation was still needed.