Omega-3 Fatty Acids and Atrial Fibrillation: Current Evidence and Expert Opinion

Recent clinical trials have reported an increased risk for atrial fibrillation (AF) in individuals treated with omega-3 fatty acids (FA). As virtually all these studies were conducted with pharmaceutical omega-3 FA preparations in populations at higher risk for cardiovascular disease (CVD), it is unclear to what extent these findings apply to the general population consuming omega-3 FA either from oily fish or from omega-3 FA supplements. Based on an updated meta-analysis reviewed here, consumption of up to 1500 mg/day (and possibly 2400 mg/day) of eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA) from food or dietary supplements in the general adult population does not appear to significantly increase risk for AF. Indeed, the preponderance of the evidence suggests that chronic intakes in this range are associated with lower risk for AF (and other CVD outcomes) in the general population. For individuals at high risk for CVD, treatment with EPA+DHA doses of >1500 mg/day might increase the absolute risk for AF (by <1%) and the relative risk (by ∼43%). Because of the favorable effects of EPA+DHA on CVD (and other health) outcomes, our view is that, for the general population, intakes of EPA+DHA afford several health benefits and do not meaningfully increase the risk for AF. For patients with prevalent CVD or at high risk for CVD, the risk-benefit ratio for EPA+DHA intake is favorable, especially for intakes up to 1500 mg/day, but also at higher doses where there may be increased risk for AF.