Association Between Omega-3 Fatty Acid Treatment and Atrial Fibrillation in Cardiovascular Outcome Trials: A Systematic Review and Meta-Analysis

Jia, Xiaoming; Gao, Feng; Pickett, June K.; Rifai, Mahmoud Al; Birnbaum, Yochai; Nambi, Vijay; Virani, Salim S.; Ballantyne, Christie M.

doi:10.1007/s10557-021-07204-z

Cited by 15 publications

(3 citation statements)

References 35 publications

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“…In addition, in the OMEMI trial, omega-3 fatty acid treatment was associated with a non-significant increase in the incidence of AF compared to the control group (7.2% vs. 4.0%; HR = 1.84; 95% CI: 0.98, 3.45; p = 0.06) [87]. Three recently published meta-analyses showed that omega-3 fatty acids are significantly associated with a dose-dependent increase in AF incidence rates [90,97,98]. On the other hand, according to findings from the VITAL-Rhythm trial, which evaluated the incidence of AF as a primary endpoint, omega-3 fatty acid administration did not increase AF episodes compared to the control group (3.7% vs. 3.4%; HR = 1.09; 95% CI: 0.96, 1.24; p = 0.19) [99].…”

Section: Omega-3 Fatty Acid Side Effectsmentioning

confidence: 99%

Classical and Novel Lipid-Lowering Therapies for Diabetic Patients with Established Coronary Artery Disease or High Risk of Coronary Artery Disease—A Narrative Clinical Review

Velidakis,

Stachteas,

Gkougkoudi

et al. 2024

Pharmaceuticals

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Diabetic atherosclerosis is a complex process that is characterized by diffuse and unstable lesions increasing 2–4-fold the risk of adverse cardiovascular (CV) events. Diabetic dyslipidemia has a predominant role in coronary artery disease (CAD) and has been the target of classical and emerging pharmaceutical agents with established or promising CV benefits. The aim of the present narrative review was to summarize the effects of classical and novel lipid-lowering pharmaceutical agents on lipid profile and CV outcomes in diabetic patients with established CAD or high risk of CAD. Statins remain the first-line treatment for all diabetic patients since they considerably ameliorate lipid parameters and non-lipid CV risk factors, leading to reduced CV morbidity and mortality. Complementary to statins, ezetimibe exerts lipid-lowering properties with modest but significant reductions in major adverse cardiovascular events (MACEs) and CV mortality. PCSK9 inhibitors considerably reduce LDL-C levels and lower MACEs in diabetic patients. On the other hand, fibrates may confer a very modest decline in MACE incidence, while the CV impact of omega-3 fatty acids is promising but remains questionable. Bempedoic acid and inclisiran have a potential therapeutic role in the management of diabetic dyslipidemia, but this is still not adequately documented. Given the heightened CV risk among individuals with diabetes, more decisive results would be of great importance in the utility of all these drugs.

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Section: Omega-3 Fatty Acid Side Effectsmentioning

confidence: 99%

Classical and Novel Lipid-Lowering Therapies for Diabetic Patients with Established Coronary Artery Disease or High Risk of Coronary Artery Disease—A Narrative Clinical Review

Velidakis,

Stachteas,

Gkougkoudi

et al. 2024

Pharmaceuticals

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“…Other studies have shown no statistically significant benefit of omega-3 supplementation in the prevention or treatment of AF. Such discrepancies may be due to differences in dosages, duration of supplementation, characteristics of study populations and different supplement formulations [7][8][9][10][11].…”

Section: A) Omega-3 Fatty Acidsmentioning

confidence: 99%

Nutritional Insights: How Food Choices Affect Atrial Fibrillation

Gondko,

Dębiec,

Roman

et al. 2024

J Educ Health Sport

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Introduction and Purpose: Atrial fibrillation (AF) is a prevalent cardiac rhythm disorder that significantly impacts global health. Emerging evidence suggests that dietary habits play a crucial role in the modulation and management of AF. This review article aims to synthesize current knowledge on the interplay between nutrition and atrial fibrillation, providing insights for healthcare professionals and patients alike in managing this condition through dietary choices.State of Knowledge: Various studies have examined the effects of specific nutrients, food groups, and dietary patterns on the incidence and progression of AF. This review delves into research linking macro- and micronutrients—such as omega-3 fatty acids, fiber, and antioxidants—to AF risk. It also evaluates the influence of dietary patterns, including Mediterranean and plant-based diets, on the electrical and structural remodeling of the heart that predisposes to AF. Additionally, the impact of excessive alcohol and caffeine consumption on AF is scrutinized, highlighting the importance of moderation.Summary: The evidence indicates a significant association between diet and atrial fibrillation, suggesting that specific dietary modifications could potentially reduce AF risk or mitigate its severity. Recommendations for clinical practice involve promoting heart-healthy dietary patterns, focusing on the balance and quality of nutrients, while considering individual dietary restrictions and preferences. Further research is needed to clarify causal relationships and to develop comprehensive dietary guidelines specific to AF management.

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“…The European Food Safety Authority considers EPA + DHA supplementation up to 5 g daily as safe, whereas the American Food and Drug Administration considers up to 3 g daily as safe [4]. However, recently, a meta-analysis of cardiovascular intervention trials observed an increase in new-onset atrial fibrillation but not stroke [42]. The relationship between the risk of atrial fibrillation and the Omega-3 Index is U-shaped, with minimum risk in the Omega-3 Index target range [43].…”

Section: Safety and Tolerabilitymentioning

confidence: 99%

Omega-3 fatty acids in heart disease—why accurately measured levels matter

Schacky¹,

Kuipers

Pijl

et al. 2023

Neth Heart J

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Current guidelines barely support marine omega‑3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in cardiology, mainly because results of large trials were equivocal. Most large trials have tested EPA alone or EPA + DHA combined as a drug, thereby disregarding the relevance of their blood levels. These levels are frequently assessed with the Omega‑3 Index (percentage of EPA + DHA in erythrocytes), which is determined using a specific standardised analytical procedure. EPA and DHA are present in every human being at unpredictable levels (even in the absence of intake), and their bioavailability is complex. Both facts need to be incorporated into trial design and should direct clinical use of EPA and DHA. An Omega‑3 Index in the target range of 8–11% is associated with lower total mortality, fewer major adverse cardiac and other cardiovascular events. Moreover, functions of organs such as the brain benefit from an Omega‑3 Index in the target range, while untoward effects, such as bleeding or atrial fibrillation, are minimised. In pertinent intervention trials, several organ functions were improved, with improvements correlating with the Omega‑3 Index. Thus, the Omega‑3 Index is relevant in trial design and clinical medicine, which calls for a widely available standardised analytical procedure and a discussion on possible reimbursement of this test.

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Association Between Omega-3 Fatty Acid Treatment and Atrial Fibrillation in Cardiovascular Outcome Trials: A Systematic Review and Meta-Analysis

Cited by 15 publications

References 35 publications

Classical and Novel Lipid-Lowering Therapies for Diabetic Patients with Established Coronary Artery Disease or High Risk of Coronary Artery Disease—A Narrative Clinical Review

Classical and Novel Lipid-Lowering Therapies for Diabetic Patients with Established Coronary Artery Disease or High Risk of Coronary Artery Disease—A Narrative Clinical Review

Nutritional Insights: How Food Choices Affect Atrial Fibrillation

Omega-3 fatty acids in heart disease—why accurately measured levels matter

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