Why the study?
Prior meta-analyses suggested omega-3 fatty acids might increase AF risk, but included at most eight trials.
Does omega-3 fatty acid treatment increase the risk of new-onset atrial fibrillation in adults aged ≥50 years?
Meta-Analysis (n=114,592)
Does omega-3 fatty acid treatment increase the risk of new-onset atrial fibrillation in adults aged ≥50 years?
Odds Ratio: 1.43 (95% CI 1.14–1.79)
High-dose omega-3 fatty acid supplementation (>1500 mg/day) is associated with an increased risk of incident atrial fibrillation specifically in patients at high cardiovascular risk.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This information should be very reassuring to patients and many clinicians who have been told that omega-3 increases AF. On the other hand, doses above 2,000 mg per day certainly seem to increase the risk of AF, but this needs to be balanced against the marked benefits that omega-3 has in meta-analyses and large RCTs.”
“Our findings show that the relationship between omega-3s and atrial fibrillation is much more nuanced than previous headlines suggested. For the vast majority of people taking nutritional doses of omega-3s, these data should provide reassurance that there is no meaningful increase in atrial fibrillation risk.”
“The decision to take or discontinue omega-3 supplements should be a discussion between a patient and his/her healthcare provider. What this study does is provide clinicians with better guidance on which patients may benefit from closer monitoring when using high-dose omega-3 therapies while reassuring consumers that it is safe to consume omega-3 fatty acids from foods and dietary supplements.”
High-dose omega-3 supplementation increases AF risk; extends prior meta-analyses and supports caution in patients at elevated arrhythmic risk.
Background: Recent meta-analyses of randomized controlled trials (RCTs) have raised concerns that treatment with omega-3 fatty acids may increase risk of atrial fibrillation (AF). However, these meta-analyses included at most eight trials. The aim of this current meta-analysis was to expand the search by including other eligible omega-3 RCTs with AF incidence data, incorporating both published and unpublished data. Methods: Eligible studies were RCTs investigating daily doses of ≥500 mg/d of 7 docosahexaenoic acid (DHA) and/or eicosapentaenoic acid (EPA). Additional inclusion criteria included ≥12 months treatment with EPA/DHA, participants ≥ 50 years of age, and where possible, the absence of known AF/atrial flutter at baseline. The primary outcome was occurrence of new-onset AF. Our primary hypothesis was that risk for AF would simultaneously depend on both omega-3 dose (above or below 1500 mg/d) and background cardiovascular disease (CVD) risk status, and that their combined impact on AF risk would be synergistic. Results: A total of 35 RCTs (37 datasets; n=114,592) were included in this meta-analysis. Only studies including patients at high-risk for CVD who were treated with high-doses of EPA/DHA (>1500 mg/day) showed a statistically significant increase in AF risk with a pooled odds ratio (OR) of 1.43 (95% CI, 1.14-1.79) and an absolute risk difference of 0.8% (0.40-1.1%). None of the other three groups showed statistically significant levels of AF risk (ORs 1.07 [high risk, low dose], 1.06 [low risk, low dose] and 1.03 [low risk, high dose]). Conclusions: This meta-analysis suggests that high-dose EPA/DHA treatment is associated with an increased risk of AF in patients at high CVD risk, whereas low-dose EPA/DHA does not appear to increase AF risk, even in high-risk populations. Further prospective studies are needed to evaluate any potential increased risk of higher doses balanced against potential benefits.
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( et al. (2026) conducted a meta-analysis in Atrial Fibrillation (n=114,592). Omega-3 Fatty Acids (EPA/DHA) vs. Placebo or control was evaluated on New-onset atrial fibrillation or flutter (OR 1.43, 95% CI 1.14-1.79).
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