Sophia Antipolis, 29 April 2021: Omega-3 supplements are associated with an increased likelihood of developing atrial fibrillation in people with high blood lipids. That's the finding of a study published today in European Heart Journal - Cardiovascular Pharmacotherapy, a journal of the European Society of Cardiology (ESC).1
"Currently, fish oil supplements are indicated for patients with elevated plasma triglycerides to reduce cardiovascular risk,"2 said study author Dr. Salvatore Carbone of Virginia Commonwealth University, US. "Due to the high prevalence of elevated triglycerides in the population, they can be commonly prescribed. Of note, low dose omega-3 fatty acids are available over the counter, without the need for a prescription."
Some clinical trials have suggested that omega-3 fatty acids may be associated with an increased risk for atrial fibrillation, the most common heart rhythm disorder. People with the disorder have a five times greater likelihood of having a stroke.3
These studies tested different formulations of omega-3 fatty acids at different doses. The authors therefore performed a comprehensive meta-analysis of randomised controlled trials to answer the question of whether fish oils were consistently related to a raised risk for atrial fibrillation.
The analysis included five randomised controlled trials investigating the effects of omega-3 fatty acid supplementation on cardiovascular outcomes. Participants had elevated triglycerides and were either at high risk for cardiovascular disease or had established cardiovascular disease. A total of 50,277 patients received fish oils or placebo and were followed up for between 2 and 7.4 years. The dose of fish oils varied from 0.84 g to 4 g per day.
The researchers found that omega-3 fatty acid supplementation was associated with a significantly increased risk for atrial fibrillation compared to placebo with an incidence rate ratio of 1.37 (95% confidence interval 1.22-1.54; p<0.001).
Dr. Carbone said: "Our study suggests that fish oil supplements are associated with a significantly greater risk of atrial fibrillation in patients at elevated cardiovascular risk. Although one clinical trial indicated beneficial cardiovascular effects of supplementation,4 the risk for atrial fibrillation should be considered when such agents are prescribed or purchased over the counter, especially in individuals susceptible to developing the heart rhythm disorder."
Authors: ESC Press Office
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Funding: S.C. was supported by a Career Development Award 19CDA34660318 from the American Heart Association and by the Clinical and Translational Science Awards Program UL1TR002649 from National Institutes of Health to Virginia Commonwealth University.
Disclosures: G.B.-Z. has consulted for Cardionovum, Innovheart, Meditrial, and Replycare. The remaining authors have nothing to disclose.
1Lombardi M, Carbone S, Del Buono MG, et al. Omega-3 fatty acids supplementation and risk of atrial fibrillation: an updated meta-analysis of randomized controlled trials. Eur Heart J Cardiovasc Pharmacother. 2021. doi:10.1093/ehjcvp/pvab008.
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2Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41:111-188.
3Hindricks G, Potpara T, Nikolaos Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020. doi:10.1093/eurheartj/ehaa612.
4Bhatt DL, Steg PG, Miller M, et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med. 2019;380:11-22.
About the European Society of Cardiology
The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.
About European Heart Journal - Cardiovascular Pharmacotherapy
European Heart Journal - Cardiovascular Pharmacotherapy reports on the interpretation and integration of new scientific developments to improve the pharmacological treatment of patients with cardiovascular disease.
European Heart Journal - Cardiovascular Pharmacotherapy