Association of new-onset atrial fibrillation in patients taking high-dose fish oil

  • Rajkumar Doshi
    Correspondence
    Corresponding author at: Department of Cardiology, St Joseph's University Medical Center, 703 Main St, Paterson, NJ 07503, USA.
    Affiliations
    Department of Cardiology, St Josephs University Medical Center, Paterson, NJ, USA
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  • Monil Majmundar
    Affiliations
    Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA

    Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA
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  • Ashish Kumar
    Affiliations
    Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA

    Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
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  • Krunalkumar Patel
    Affiliations
    Department of Internal Medicine, St Mary Medical Center, Langhorn, PA, USA
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  • Saraschandra Vallabhajosyula
    Affiliations
    Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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  • Ankur Kalra
    Affiliations
    Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA

    Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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Published:September 27, 2021DOI:https://doi.org/10.1016/j.ejim.2021.09.010
      Atrial fibrillation (AF) is the most common cardiac arrythmia, with an estimate of 37.6 million cases (0.51% of the world population) in 2017. Its prevalence has increased by 33% in the last 20 years and future projections suggest that the burden could increase by more than 60% by 2050. AF is associated with an increased risk of stroke, cardiovascular disease, renal disease, and mortality. Thus, primary prevention of AF would be an important measure to reduce healthcare burden. In recent times, researchers have investigated whether dietary supplements have a role in the prevention of AF. In observational studies, individuals with high blood levels of long-chain n-3 polyunsaturated fatty acids (n-3 PUFAs) and docosahexaenoic acid (DHA) had a lower incidence of AF. However, data from four randomized control trials (RCTs) regarding supplemental intake of omega-3 fatty acids and the incidence of AF showed mixed results [
      • Bhatt DL
      • Steg PG
      • Miller M
      • Brinton EA
      • Jacobson TA
      • Ketchum SB
      • Doyle Jr., RT
      • Juliano RA
      • Jiao L
      • Granowitz C
      • Tardif JC
      Ballantyne CM and investigators R-I. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia.
      ,
      • Albert CM
      • Cook NR
      • Pester J
      • Moorthy MV
      • Ridge C
      • Danik JS
      • Gencer B
      • Siddiqi HK
      • Ng C
      • Gibson H
      • Mora S
      • Buring JE
      • Manson JE.
      Effect of marine omega-3 fatty acid and vitamin d supplementation on incident atrial fibrillation: a randomized clinical trial.
      ,
      • Nicholls SJ
      • Lincoff AM
      • Garcia M
      • Bash D
      • Ballantyne CM
      • Barter PJ
      • Davidson MH
      • Kastelein JJP
      • Koenig W
      • McGuire DK
      • Mozaffarian D
      • Ridker PM
      • Ray KK
      • Katona BG
      • Himmelmann A
      • Loss LE
      • Rensfeldt M
      • Lundstrom T
      • Agrawal R
      • Menon V
      • Wolski K
      • Nissen SE.
      Effect of high-dose omega-3 fatty acids vs corn oil on major adverse cardiovascular events in patients at high cardiovascular risk: the strength randomized clinical trial.
      ,
      • Kalstad AA
      • Myhre PL
      • Laake K
      • Tveit SH
      • Schmidt EB
      • Smith P
      • Nilsen DWT
      • Tveit A
      • Fagerland MW
      • Solheim S
      • Seljeflot I
      • Arnesen H
      • Investigators O
      Effects of n-3 fatty acid supplements in elderly patients after myocardial infarction: a randomized, controlled trial.
      ]. Hence, we conducted a meta-analysis to investigate the association between omega-3 fatty acids and the incidence of AF Fig. 1.
      Fig 1
      Fig. 1Forest plot showing risk ratio of atrial fibrillation in patients taking fish oil compared with placebo.
      The risk ratio for each individual study is indicated by square and 99% CIs by horizontal line. Overall totals and their 95% confidence intervals are represented by diamonds. The size of the squares and the diamonds are proportional to the statistical information conveyed.
      Abbreviations: RR- Risk ratio; CI- Confidence interval

      Keywords

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      References

        • Bhatt DL
        • Steg PG
        • Miller M
        • Brinton EA
        • Jacobson TA
        • Ketchum SB
        • Doyle Jr., RT
        • Juliano RA
        • Jiao L
        • Granowitz C
        • Tardif JC
        Ballantyne CM and investigators R-I. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia.
        N Engl J Med. 2019; 380: 11-22
        • Albert CM
        • Cook NR
        • Pester J
        • Moorthy MV
        • Ridge C
        • Danik JS
        • Gencer B
        • Siddiqi HK
        • Ng C
        • Gibson H
        • Mora S
        • Buring JE
        • Manson JE.
        Effect of marine omega-3 fatty acid and vitamin d supplementation on incident atrial fibrillation: a randomized clinical trial.
        JAMA. 2021; 325: 1061-1073
        • Nicholls SJ
        • Lincoff AM
        • Garcia M
        • Bash D
        • Ballantyne CM
        • Barter PJ
        • Davidson MH
        • Kastelein JJP
        • Koenig W
        • McGuire DK
        • Mozaffarian D
        • Ridker PM
        • Ray KK
        • Katona BG
        • Himmelmann A
        • Loss LE
        • Rensfeldt M
        • Lundstrom T
        • Agrawal R
        • Menon V
        • Wolski K
        • Nissen SE.
        Effect of high-dose omega-3 fatty acids vs corn oil on major adverse cardiovascular events in patients at high cardiovascular risk: the strength randomized clinical trial.
        JAMA. 2020; 324: 2268-2280
        • Kalstad AA
        • Myhre PL
        • Laake K
        • Tveit SH
        • Schmidt EB
        • Smith P
        • Nilsen DWT
        • Tveit A
        • Fagerland MW
        • Solheim S
        • Seljeflot I
        • Arnesen H
        • Investigators O
        Effects of n-3 fatty acid supplements in elderly patients after myocardial infarction: a randomized, controlled trial.
        Circulation. 2021; 143: 528-539
        • Nigam A
        • Talajic M
        • Roy D
        • Nattel S
        • Lambert J
        • Nozza A
        • Jones P
        • Ramprasath VR
        • O'Hara G
        • Kopecky S
        • Brophy JM
        • Tardif JC
        • Investigators A.
        Fish oil for the reduction of atrial fibrillation recurrence, inflammation, and oxidative stress.
        J Am Coll Cardiol. 2014; 64: 1441-1448