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Background: Cats with subclinical hypertrophic cardiomyopathy (sHCM) have elevated serum insulin levels and serum amyloid A levels correlating with the degree of cardiac hypertrophy. Diet might affect these parameters and other cardiac variables.Objective: Evaluate the effect of a complete, balanced diet with restricted starch and supplemented with eicosapentanoic acid+docosahexaenoic acid (EPA+DHA) on echocardiographic parameters and cardiac biomarkers in cats with sHCM.Animals: Forty-four client-owned cats with sHCM. Methods: A prospective, randomized, double-blind, multicenter study enrolled cats with end-diastole interventricular septum thickness (IVSd) and/or left ventricular wall thickness (LVWd) ≥6 mm. Non-sedated, fasted cats were examined at baseline and after 6 and 12 months of Test (restricted starch and EPA+DHA supplements) (n=23) or Control (unrestricted starch without EPA+DHA supplementation) (n=21) diet. Assessments included auscultation, body weight, body condition score, echocardiography and blood analysis. Linear and generalized mixed models analyzed diet, time and diet*time interactions (5% significance level). Results: No differences between diet groups were significant for any variable at any timepoint. There were significant decreases in the Test but not Control group in maximum IVSd (P = .031; P = .524), maximum LVWd (P = .022; P = .905) and insulin-like growth factor-1 levels (P = .036; P = .987) after 12 months, and in ultra-sensitive cardiac troponin I (cTnI) (P = .001; P = .745) after 6 months only.Conclusions and clinical importance: Significant decreases in echocardiographic variables of sHCM, cTnI and IGF-1, were observed in the Test group. Further research is needed to evaluate effects on clinical outcomes.