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Why people at risk for heart disease may want to avoid fish oil

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A new study looks at the risk of taking omega-3 supplements for people at high risk for heart disease. Getty Images
  • A new study finds that taking omega-3 supplements is associated with an increased risk of atrial fibrillation in people at high risk for heart disease or pre-existing heart disease.
  • Experts say the link between the use of omega-3 supplements and heart health is complex.
  • Talk to your doctor about your risks and what is best for you.

While previous research found strong evidence that omega-3 fatty acids are good for heart health, this popular supplement can also carry a significant risk for some people.

According to a new analysis by the European Society of Cardiology, omega-3 fatty acid supplements have been linked to an increased likelihood of developing atrial fibrillation (AFib) in people with high triglyceride levels.

Triglycerides are a type of fat found in the blood.

“Fish oil supplements are currently indicated for patients with elevated plasma triglycerides to reduce cardiovascular risk,” said study author Salvatore Carbone, MD, of the University of Virginia in the British Community.

“Due to the high prevalence of elevated triglycerides in the population, they can be prescribed frequently,” he added.

The new analysis looked at five randomized controlled trials and looked at the effects of omega-3 fatty acid supplements on cardiovascular outcomes.

Study participants had high levels of triglycerides. They were at increased risk of cardiovascular disease or had already been diagnosed with it.

More than 50,000 participants received fish oil (a source of omega-3) or a placebo. The researchers followed them for up to 7.4 years. The dosage of fish oil is between 0.84 grams and 4 grams per day.

The researchers found that the addition of omega-3 fatty acids was associated with a significantly increased risk of AFib compared with placebo.

“Atrial fibrillation is an arrhythmia, an abnormal heart rhythm characterized by irregular electrical activity in the upper ventricle of the heart, the left atrium,” said Dr. Michael Goifman, director of clinical cardiology at Long Island’s Jewish Forest Hills in New York, New York.

“While some people may feel [heart] palpitations in atrial fibrillation, others have no symptoms, ”he said.

Goifman added that AFib’s main concern is the risk of stroke or other thromboembolic event, in which a blood clot can form in the heart and then break off and move to the brain or other organs.

“To reduce this risk, blood thinners are often prescribed to patients with AFib at a higher risk of stroke,” Goifman said.

Omega-3s are essential fats that the body needs to stay healthy.

According to the National Institutes of Health, omega-3s are not produced in the body. We need to consume them to maintain healthy levels.

Omega-3 is available in three types:

  • alpha-linolenic acid (ALA)
  • eicosapentaenoic acid (EPA)
  • docosahexaenoic acid (DHA)

The National Institutes of Health emphasizes that omega-3s are an important part of the membranes that surround every cell in our bodies.

DHA levels are particularly high in the eyes, brain and sperm and play an important role in many bodily functions.

Goifman confirmed that for healthy people who consume omega-3 as part of a diet such as the Mediterranean diet, “the incidence of cardiovascular events is significantly reduced.”

Scientific advice for 2019, published in the journal Circulation, says that 4 grams a day of prescription omega-3 can lower triglyceride levels by 20 to 30 percent in most people.

But how important is reducing these levels?

“Triglycerides are a type of fat in our bodies and their levels are measured by a blood test, similar to other fats such as HDL, ‘good’ cholesterol and LDL, ‘bad’ cholesterol,” Goifman said.

“Although there is some association between high triglyceride levels and cardiovascular disease, a causal relationship has never been established,” he said, “and we do not currently use triglyceride levels to calculate someone’s risk of stroke or heart attack. “

Asked if the benefits of omega-3 supplements for healthy people outweigh their potential risks, Dr. Lawrence M. Epstein, system director of electrophysiology at Northwell Health’s Sandra Atlas Bass Heart Hospital in New York, said it was “unclear.”

“This remains controversial and that’s why this study was done,” Epstein said. “Some claim that they can reduce the risk of coronary artery disease by affecting lipids such as triglycerides. Others suggest that they may reduce the risk of life-threatening heart rhythm problems. “

Epstein emphasized the importance of telling your doctor what supplements you are taking.

“It is extremely important that patients inform their doctors everything the supplements they take, ”he said. “This study suggests that if you have atrial fibrillation, you may need to avoid these supplements.”

“The REDUCE-IT study showed that patients with high triglycerides who took specific omega-3 prescription-only supplements reduced their risk of cardiovascular events, including cardiovascular death,” Goifman said. “As such, it’s a complex issue to consider.”

According to Goifman, AFib can be treated with appropriate drugs, procedures or both. The risk of stroke can be reduced by taking blood thinners.

“Some may argue that reducing deaths outweighs the risk of developing atrial fibrillation,” Goifman said.

“On the other hand,” he warned, “people who are not in a category where they can benefit from omega-3 supplements may take an unnecessary risk of developing atrial fibrillation. “

Goifman said it was important to keep in mind that there are different types of omega-3s.

“Only EPA was used in the REDUCE-IT test, and a mixture of EPA and DHA TEST FORCEwhich did not show any benefit, “he said.

“Maybe if we used different compounds, do we compare apples to oranges?” Goifman said.

Until further research is done on specific types and dosages of omega-3s, Goifman “would not recommend that patients decide to either stop or start omega-3 supplements without talking to their doctor.”

Epstein added that many supplements are poorly regulated, often have no warnings and need to be better regulated in general.

A new study finds that taking omega-3 supplements is associated with an increased risk of atrial fibrillation in people at high risk for heart disease or pre-existing heart disease.

Experts say that while omega-3s are essential for health, the link between the use of these supplements and heart health is complex.

They also say that supplements are generally poorly regulated. It is best to talk to your doctor before including omega-3 supplements in your diet.

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