Omega 3 supplements linked with heart rhythm disorder in meta-analysis

30 Apr 2021 --- A study taking over 50,000 people with high blood lipids into account has revealed an association between omega 3 supplements and an increased likelihood of developing atrial fibrillation (AF). However, industry experts emphasize the safety of omega 3 supplements to NutritionInsight, arguing that the benefits outweigh the risks.

“Currently, fish oil supplements are indicated for patients with elevated plasma triglycerides to reduce cardiovascular risk,” says study author Dr. Salvatore Carbone of Virginia Commonwealth University, US.

“Due to the high prevalence of elevated triglycerides in the population, they can be commonly prescribed. Notably, low-dose omega 3 fatty acids are available over the counter, without the need for a prescription,” he adds.

Carbone argues that risk for AF should be considered when such agents are prescribed or purchased over the counter, especially in individuals susceptible to developing the heart rhythm disorder.

AF is the most common heart rhythm disorder. People with the disorder have a five times greater likelihood of having a stroke.Richards of DSM points out that adverse effects are likely to occur as a result of a particular study design.

Stronger restrictions?
However, the results have not led the Global Organization for EPA and DHA Omega 3s (GOED) to conclude that the sale of omega 3s should be restricted, according to Harry Rice, GOED’s vice president of regulatory and scientific affairs.

Jim Richards, DSM’s vice president of nutrition science and advocacy, also agrees that tighter controls of omega 3 fatty acid supplements are not necessary. 

“While it is important to continue to assess new data as they come in, the available data strongly argue for the safety of omega 3 supplementation and its efficacy for a number of beneficial outcomes, including for cardiovascular health,” he details. 

The European Food Safety Authority (EFSA) states that supplemental intakes of DHA and EPA of up to 5 g per day do not pose a safety concern for adults. In addition, there are approved health claims for omega 3 supplementation and cardiovascular health, including in Europe and the US.  

Significantly increasing risk
The study, now published in European Heart Journal – Cardiovascular Pharmacotherapy, was a comprehensive meta-analysis of five randomized controlled trials investigating the effects of omega 3 fatty acid supplementation on cardiovascular outcomes.

Participants had elevated triglycerides and were either at high risk for cardiovascular disease or had established cardiovascular disease. A total of 50,277 patients received fish oils or placebo and were followed for between 2 and 7.4 years. The dose of fish oils varied from 0.84 g to 4 g per day.

The researchers found that omega 3 fatty acid supplementation was associated with a significantly increased risk for AF compared to placebo with an incidence rate ratio of 1.37.

“Our study suggests that fish oil supplements are associated with a significantly greater risk of AF in patients at elevated cardiovascular risk,” Carbone notes.GOED has been examining the link between AF and EPA/DHA supplementation since November and expects to have more answers “in a few months.”

Benefits outweigh risk
Pending further evaluation of the totality of the available scientific evidence and based upon what we know today, the benefits of omega 3 supplementation outweigh the risk of AF, argues Rice of GOED.

Andrea Wong, senior vice president of scientific & regulatory affairs at the Council for Responsible Nutrition (CRN), adds that science demonstrating the benefit and safety of omega 3 fatty acid supplementation for heart health is well-established.

“In addition to cardiovascular health, omega 3s are important nutrients for brain and eye development, cognitive health and other basic human functions,” she details. 

Richards also points to a meta-analysis of 40 clinical studies, including over 135,000 participants. It found that omega 3 supplementation was associated with a 13 percent reduced risk of heart attacks, 35 percent reduced risk of fatal heart attacks, 10 percent reduced risk of coronary heart disease events and 9 percent reduced risk of coronary heart disease mortality.

A fast-moving space
According to Innova Market Insights, the top category of global product launches in 2020 tracked with a heart health claim was Supplements (54 percent), with EPA being the leading ingredient among nutraceutical and functional ingredients tracked.

Recent launches in this space include Thai Union Ingredients’ DHA omega 3 oils made with valorized tuna fish heads. Aker BioMarine also recently shared krill oil’s potential for liver health, skin hydration and muscle activation in sports performance.

Earlier this month, DSM’s ARA and DHA supplement was found to help reduce the risk of severe retinopathy of prematurity in extremely premature infants.

Additionally, a BASF-funded study detailed the specific roles of DHA and EPA in sleep quality. 

By Katherine Durrell