Omega-3 fatty acid supplementation can increase the likelihood of atrial fibrillation in certain high-risk patients

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Lombardi does not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors.

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Omega-3 fatty acid supplementation was associated with an increased risk of atrial fibrillation in patients with elevated triglyceride levels and high cardiovascular risk, the researchers reported.

“Omega-3 fatty acids are used in clinical practice to reduce the risk of cardiovascular disease in patients with elevated plasma triglycerides,” Marco Lombardi, MD, Associate Professor in the Department of Cardiovascular and Thoracic Sciences at the Catholic University of the Sacred Heart in Rome, and colleagues wrote a research letter to the European Heart Journal: Cardiovascular Pharmacotherapy. “However, safety has been questioned as several CV outcome studies with omega-3 fatty acids supplementation showed a potential increase in AF compared to placebo.”

Omega-3 fatty acid supplementation was associated with an increased risk of atrial fibrillation in patients with elevated triglyceride levels and high cardiovascular risk. The data were from Lombardi M, et al. Eur Heart J Cardiovasc Pharmacother. 2021; doi: 10.1093 / ehjcvp / pvab008.

Researchers conducted a meta-analysis of randomized controlled trials of omega-3 fatty acid supplementation on cardiovascular endpoints, including the incidence of atrial fibrillation, through November 2020. Studies included were the REDUCE IT study with 8,179 patients (mean age 64 years; 71% men), the ASCEND study with 15,480 patients (mean age 63 years; 63% men), and the R&P study with 12,513 patients (mean age 64 Years; 61% men), the STRENGTH study with 13,078 patients (mean age 63 years; 65% men) and the OMEMI study with 1,027 patients (mean age 75 years; 71% men).

The primary endpoint was the occurrence of atrial fibrillation.

Omega-3 fatty acid supplementation was associated with an increased risk of atrial fibrillation (incidence rate ratio [IRR] = 1.37; 95% CI 1.22-1.54; P <.001) compared to placebo in the random effect model. In the sensitivity analysis, the researchers included the VITAL Rhythm study and found a higher risk of atrial fibrillation in patients who received omega-3 fatty acid supplementation (IRR = 1.29; 95% CI, 1.13-1.48 ; P = 0.0002) compared to those who received placebo.

The researchers did not observe any significant statistical heterogeneity between the studies or any publication bias.

According to the researchers, the conflicting results of the positive effects of omega-3 fatty acid supplementation on cardiovascular outcomes, along with the potential risk of harm, underscore the need for future studies to unequivocally confirm the positive effects of this class of drugs.

“Our study suggests that omega-3 fatty acid supplementation is associated with an increased risk of atrial fibrillation in patients with elevated plasma triglycerides and an increased cardiovascular risk,” the researchers write. “This suggests that the risk of atrial fibrillation should be considered when prescribing omega-3 fatty acid supplementation for this population.”

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