Key result
High-dose EPA reduces residual cardiovascular risk but increases incident atrial fibrillation risk.
Why the study?
High-dose EPA reduces cardiovascular events in high-risk patients, but concerns remain regarding the risk of AF and guidelines provide no specific indications for AF risk evaluation.
Does high-dose eicosapentaenoic acid reduce cardiovascular events while increasing the risk of atrial fibrillation in patients at high cardiovascular risk?
Does high-dose eicosapentaenoic acid reduce cardiovascular events while increasing the risk of atrial fibrillation in patients at high cardiovascular risk?
High-dose EPA effectively reduces residual cardiovascular risk but necessitates a structured approach for monitoring and managing the associated risk of incident atrial fibrillation.
Requires AF monitoring during high-dose EPA in high CV-risk patients; leaves open precise selection criteria for prospective validation.
In recent years, scientific research has increasingly focused on the cardiovascular benefits of omega-3 polyunsaturated fatty acids (n-3 PUFAs) supplements. The most promising results emerged from the new trials on a high-dose eicosapentaenoic acid (EPA)-only approach, instead of the previously prescribed therapy with EPA + docosahexaenoic acid (DHA). The evidence of the reduction of cardiovascular events in patients at high cardiovascular risk with EPA is intriguing. However, physicians have expressed concern about the potential high risk of atrial fibrillation (AF) occurrence due to such an approach. This study aims to investigate the current evidence on the cardiovascular benefits of EPA and its association with atrial arrhythmogenesis. Current guidelines consider EPA (as IPE) treatment for selected patients but with no specific indication regarding AF risk evaluation. We propose a flowchart that could be a starting point for the future development of an algorithm to help clinicians to prescribe EPA safely and effectively, especially in patients at high risk of incipient AF.
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Egalini et al. (2023) conducted a review in Cardiovascular disease and hypertriglyceridemia. Eicosapentaenoic acid (EPA) vs. Placebo or EPA + DHA was evaluated. High-dose EPA therapy reduces residual cardiovascular risk but is associated with an increased risk of incident atrial fibrillation, prompting the need for careful patient selection.
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