Fish oil supplements linked with heart rhythm disorder

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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.

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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.”

ENDS

Notes to editor

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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.

References

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.

Link will go live on publication:

https://academic.oup.com/ehjcvp/article-lookup/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.

3HindricksG, 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 ESC brings together health care professionals from more than 150 countries, working to
advance cardiovascular medicine and help people to live 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.

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