IFM’s Advanced Practice Modules (APM) offer insight into a range of clinical conundrums and provide useful clinical pearls on approaching care through the functional medicine lens. Below is a question that is frequently asked by attendees during the program. Stay tuned for more clinical question-and-answers coming soon!
Is there a risk of atrial fibrillation (AF) with omega-3 supplementation?
Over the past few years, large omega-3 studies looking at cardiovascular outcomes have observed an increased risk of atrial fibrillation as an adverse event. It appears to be dose-dependent, based on a 2021 AHA systematic review of seven studies. This review found that the risk was greatest with doses >1 g/day of combined EPA/DHA. The absolute risk was low (average=0.825%; median=0.5%) but consistent. Therefore, there is reason to be cautious until further research clarifies these findings.1 It is unclear what exactly is causing the increase in AF in these studies, but other variables to consider include age, CVD hx, dose, EPA/DHA blood levels, lifestyle factors, and antioxidant intake.2-5
Although there is still much that is unknown about omega 3s and AF risk, we do know that omega 3s have many benefits for cardiometabolic conditions, including anti-inflammatory and lipid-lowering effects. Therefore, supplementation remains a part of a comprehensive personalized treatment approach, weighing the risks vs. benefits of treatment for each patient.
Clinical takeaways:
- Always discuss risk vs. benefit of treatment with your patients.
- Make sure healthy lifestyle factors are in place (weight, movement, quitting drinking and smoking, etc.) to decrease risk of AF.5
- Depending on the risks, start with a lower dose; younger age and no prior hx of CVD may be protective. <1 gram is associated with the lowest risk. History of MI appears to have the greatest risk.1,2,4
- Adding antioxidants with omega 3s may decrease risk and actually be protective of AF (especially post-operative AF).3
- When available, check omega-3 levels in patients prior to supplementation to determine the appropriate dose. Monitor and adjust dose based on level.
Learn more about nutrient supplementation to support heart health at the Cardiometabolic Advanced Practice Module (APM).
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REFERENCES
- Gencer B, Djousse L, Al-Ramady OT, Cook NR, Manson JE, Albert CM. Effect of long-term marine omega-3 fatty acids supplementation on the risk of atrial fibrillation in randomized controlled trials of cardiovascular outcomes: a systematic review and meta-analysis. Circulation. 2021;144(25):1981-1990. doi:10.1161/CIRCULATIONAHA.121.055654
- Albert CM, Cook NR, Pester J, et al. Effect of marine omega-3 fatty acid and vitamin D supplementation on incident atrial fibrillation: a randomized clinical trial. JAMA. 2021;325(11):1061-1073. doi:10.1001/jama.2021.1489
- Rodrigo R, Korantzopoulos P, Cereceda M, et al. A randomized controlled trial to prevent post-operative atrial fibrillation by antioxidant reinforcement. J Am Coll Cardiol. 2013;62(16):1457-1465. doi:10.1016/j.jacc.2013.07.014
- Wasmer K, Eckardt L, Breithardt G. Predisposing factors for atrial fibrillation in the elderly. J Geriatr Cardiol. 2017;14(3):179-184. doi:10.11909/j.issn.1671-5411.2017.03.010
- Larsson SC, Drca N, Jensen-Urstad M, Wolk A. Combined impact of healthy lifestyle factors on risk of atrial fibrillation: prospective study in men and women. Int J Cardiol. 2016;203:46-49. doi:10.1016/j.ijcard.2015.10.106