Omega-3 fatty acid supplements and risk of atrial fibrillation and 'micro-atrial fibrillation': A secondary analysis from the OMEMI trial

Peder L Myhre; Trygve Berge; Are A Kalstad; Sjur H Tveit; Kristian Laake; Erik B Schmidt; Svein Solheim; Harald Arnesen; Ingebjørg Seljeflot; Arnljot Tveit

doi:10.1016/j.clnu.2023.07.002

Omega-3 fatty acid supplements and risk of atrial fibrillation and 'micro-atrial fibrillation': A secondary analysis from the OMEMI trial

Clin Nutr. 2023 Sep;42(9):1657-1660. doi: 10.1016/j.clnu.2023.07.002. Epub 2023 Jul 19.

Authors

Affiliations

¹ Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Norway. Electronic address: p.l.myhre@medisin.uio.no.
² Institute of Clinical Medicine, University of Oslo, Norway; Department of Medical Research, Vestre Viken Hospital Trust, Bærum Hospital, Gjettum, Norway.
³ Institute of Clinical Medicine, University of Oslo, Norway; Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.
⁴ Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
⁵ Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.
⁶ Aalborg University, Aalborg, Denmark.

PMID: 37515843
DOI: 10.1016/j.clnu.2023.07.002

Abstract

Background & aims: Recent randomized clinical trials have raised concerns regarding potential off target adverse effects from supplementation of n-3 polyunsaturated fatty acids (PUFA) on atrial fibrillation (AF) risk. We aimed to assess risk and potential mediators of AF and 'micro-AF' from n-3 PUFA in post-myocardial infarction (MI) patients.

Methods: In the OMEMI trial, 70-82 y. o. patients with a recent MI were randomized to 1.8 g/day of eicosapentaenoic-/docosahexaenoic acid (EPA/DHA) or placebo (corn oil) for two years. New-onset AF and 'micro-AF' was recorded by clinical detection and by screening with Zenicor thumb-ECG (adjudicated by blinded investigators). Serum EPA and DHA were measured at baseline and study end.

Results: At baseline, 759 of 1014 (75%) patients had no AF history. These patients were aged 75 ± 4 years and 71% were male. During follow-up, 43 patients developed new-onset AF (39 clinically-detected and 4 by thumb-ECG screening). In addition, 27 patients had episodes of micro-AF, yielding a total of 70 patients with new-onset AF or 'micro-AF'. In the n-3 PUFA group 46 (11.9%) had AF/'micro-AF' (28 AF, 18 'micro-AF') and in the placebo group 24 (6.5%) had AF/micro-AF (15 AF, 9 micro-AF); HR 1.90 (95%CI 1.16-3.11), P = 0.011. Changes in serum EPA (but not DHA) mediated the effect from n-3 PUFA on AF risk, explaining 65% of the association.

Conclusion: Supplementation of n-3 PUFA post MI increases the risk of 'micro-AF' and AF, and increases in EPA seems to be an important mediator of the treatment effect from n-3 PUFA on the risk of AF.

Study registration: OMEMI Study; ClinicalTrails.gov identifier: NCT0184194.

Keywords: Atrial fibrillation; Docosahexaenoic acid; Eicosapentaenoic acid; Omega-3 PUFA.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Atrial Fibrillation* / drug therapy
Atrial Fibrillation* / prevention & control
Dietary Supplements
Docosahexaenoic Acids
Eicosapentaenoic Acid / adverse effects
Fatty Acids, Omega-3*
Female
Humans
Male
Myocardial Infarction* / drug therapy
Myocardial Infarction* / epidemiology
Myocardial Infarction* / prevention & control

Substances

Fatty Acids, Omega-3
Eicosapentaenoic Acid
Docosahexaenoic Acids

Associated data

ClinicalTrials.gov/NCT0184194