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Background: Cats with subclinical hypertrophic cardiomyopathy (sHCM) have elevated serum insulin and serum amyloid A concentrations correlating with the degree of cardiac hypertrophy. Diet might affect these and other cardiac variables. Objective: Evaluate the effect of a complete, balanced diet with restricted starch and supplemented with eicosapentaenoic acid + docosahexaenoic acid (EPA + DHA) on echocardiographic variables 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) or left ventricular wall thickness (LVWd) ≥6 mm, or both. Nonsedated, 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 =.03), maximum LVWd (P =.02) and insulin‐like growth factor‐1 levels (P =.04) after 12 months, and in ultrasensitive cardiac troponin I (cTnI) (P =.001) after 6 months; effect sizes (95% confidence interval) were 0.53 (0.09; 0.99), 0.63 (0.18; 1.09), 0.61 (0.16; 1.07), and 0.37 (−0.06; 0.8), respectively. Conclusions and Clinical Importance: Cats with sHCM fed Test diet had significant decreases in echocardiographic variables of sHCM and in cTnI and IGF‐1. [ABSTRACT FROM AUTHOR]