Omega-3 fatty acid supplementation may increase AF odds in certain high-risk patients
Omega-3 fatty acid supplementation was associated with elevated risk for atrial fibrillation among patients with elevated triglyceride levels at high CV risk, researchers reported.
“Omega-3 fatty acids supplementation are being utilized in clinical practice to reduce CVD risk 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, Rome, and colleagues wrote in a research letter to European Heart Journal: Cardiovascular Pharmacotherapy. “Safety has been, however, questioned as several CV outcomes trials of omega-3 fatty acid supplementation showed a potential increase of AF when compared with placebo.”
Researchers conducted a meta-analysis of randomized controlled trials of omega-3 fatty acids supplementation on CV outcomes, including incidence of AF, up to November 2020. Studies included were the REDUCE IT study of 8,179 patients (mean age, 64 years; 71% men), the ASCEND study of 15,480 patients (mean age, 63 years; 63% men), the R&P study of 12,513 patients (mean age, 64 years; 61% men), the STRENGTH study of 13,078 patients (mean age, 63 years; 65% men) and the OMEMI study of 1,027 patients (mean age, 75 years; 71% men).
The primary endpoint was onset of AF.
Omega-3 fatty acid supplementation was associated with an increased risk for incident AF (incidence rate ratio [IRR] = 1.37; 95% CI, 1.22-1.54; P < .001) compared with the placebo in the random effect model. In the sensitivity analysis, researchers included the VITAL Rhythm trial and results confirmed higher risk for AF among patients receiving omega-3 fatty acid supplementation (IRR = 1.29; 95% CI, 1.13-1.48; P = .0002) compared with those receiving placebo.
Researchers observed no significant statistical heterogeneity between studies as well as no publication bias.
According to the researchers, the conflicting results of beneficial effects of omega-3 fatty acid supplementation on CV outcomes along with the potential risk for harm highlights the need for future studies to firmly confirm the beneficial effects of this class of drugs.
“Our study suggests that omega-3 fatty acid supplementation is associated with an increased risk of AF in patients with elevated plasma triglyceride and at elevated CV risk,” the researchers wrote. “This proposes that the risk of AF should be considered when prescribing omega-3 fatty acid supplementation in this population.”