Cardiovascular Journal of Africa: Vol 32 No 3 (MAY/JUNE 2021)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 3, May/June 2021 AFRICA 167
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Omega-3 supplementation linked with atrial fibrillation risk: a meta-analysis
Omega-3 supplements are associated with an increased
likelihood of developing atrial fibrillation in people with high
blood lipids, a meta-analysis of randomised control trials
published in the European Heart Journal found.
‘Currently, fish oil supplements are indicated for patients
with elevated plasma triglycerides to reduce cardiovascular
risk,’ said study author Dr Salvatore Carbone of Virginia
Commonwealth University, USA. ‘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.
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 two and 7.4 years. The dose of fish
oils varied from 0.84 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).
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, 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.’
Source: European Heart Journal 2021