Fish Oil and Atrial Fibrillation

[Shute]

Fish oil (DHA + EPA) has a reputation for being heart-healthy, but some data are showing it can increase your chances of getting Atrial Fibrillation, or AFib. This is an electrical issue of the heart whereby your a node of your heart essentially goes haywire and starts sending out erratic electrical signals to your atria, causing rapid heart beat and palpitations. Some of these attacks terminate on their own after several hours or days, others require medication or electric cardioversion in the hospital ED. Having Afib increases your chance of getting a stroke by over 5x, as your blood does not circulate in the heart correctly and is prone to clotting.

Study below was a large meta-analysis showing an increased risk with higher doses of fish oil. Note the average age of the test subjects are 65, but still concerning.

Effect of Long-Term Marine ɷ-3 Fatty Acids Supplementation on the Risk of Atrial Fibrillation in Randomized Controlled Trials of Cardiovascular Outcomes: A Systematic Review and Meta-Analysis - PubMed

In RCTs examining cardiovascular outcomes, marine ɷ-3 supplementation was associated with an increased risk of AF. The risk appeared to be greater in trials testing >1 g/d.

pubmed.ncbi.nlm.nih.gov

Quick review by an electrophysiologist (specialist cardiologist) of some of the literature out there

Fish Oil and Atrial Fibrillation - Dr. AFib

Delve into the extensive examination of the potential risks associated with high-dose fish oil supplementation for heart health, which encompasses its connection to atrial fibrillation, a common heart rhythm disorder characterized by irregular and rapid beating of the atria. This comprehensive...

drafib.com

It's been a while, but I recall seeing some literature that certain AAS increase your risk for Afib and ventricular arrythmia as well, so something to keep an eye on.

If you have a family history of AFib, or have any of the risk factors that predispose you to it, it may be a consideration to have a discussion with a cardiologist (not GP) to see if the risk/reward is worth it for fish oil

Shute

 

[gondar1]

Fish oil (DHA + EPA) has a reputation for being heart-healthy, but some data are showing it can increase your chances of getting Atrial Fibrillation, or AFib. This is an electrical issue of the heart whereby your a node of your heart essentially goes haywire and starts sending out erratic electrical signals to your atria, causing rapid heart beat and palpitations. Some of these attacks terminate on their own after several hours or days, others require medication or electric cardioversion in the hospital ED. Having Afib increases your chance of getting a stroke by over 5x, as your blood does not circulate in the heart correctly and is prone to clotting.

Study below was a large meta-analysis showing an increased risk with higher doses of fish oil. Note the average age of the test subjects are 65, but still concerning.

Effect of Long-Term Marine ɷ-3 Fatty Acids Supplementation on the Risk of Atrial Fibrillation in Randomized Controlled Trials of Cardiovascular Outcomes: A Systematic Review and Meta-Analysis - PubMed

In RCTs examining cardiovascular outcomes, marine ɷ-3 supplementation was associated with an increased risk of AF. The risk appeared to be greater in trials testing >1 g/d.

pubmed.ncbi.nlm.nih.gov

Quick review by an electrophysiologist (specialist cardiologist) of some of the literature out there

Fish Oil and Atrial Fibrillation - Dr. AFib

Delve into the extensive examination of the potential risks associated with high-dose fish oil supplementation for heart health, which encompasses its connection to atrial fibrillation, a common heart rhythm disorder characterized by irregular and rapid beating of the atria. This comprehensive...

drafib.com

It's been a while, but I recall seeing some literature that certain AAS increase your risk for Afib and ventricular arrythmia as well, so something to keep an eye on.

If you have a family history of AFib, or have any of the risk factors that predispose you to it, it may be a consideration to have a discussion with a cardiologist (not GP) to see if the risk/reward is worth it for fish oil

Shute

This is an important post, thank you.

Tough to recommend against FO based on this though. I definitely am biased towards using large amounts of it, I usually include 12 grams in my diet daily. This bias didn't just come on a whim however but rather from a ton of reading and a thorough examination of cited studies. As is often the case most of the studies have major flaws which disqualify them from having any clear cut meaningful conclusions. This "Meta" Study (the Pubmed one) has it's own issues starting with an obvious narrowness of scope but their are others. Some of the data referenced clearly shows no benefit or harm as far as afib goes.

The second link refers to a large study that found FO made no difference either way, but notably does give mention it's ability to (may) lower triglycerides by 20-30%.

Some of the data used is results based on script products that could arguably not even be called "fish oil" due to how it's been manipulated by adding and subtracting components like DHA and EPA.



I feel like the already barely significant numbers need to be looked at with a large grain of salt, step back and see the overall effect. One quick example - "In that trial, dubbed REDUCE-IT, patients using a product called Vascepa (icosapent ethyl) saw their risk of "cardiovascular events" drop by 25%. That included heart attack, stroke and death from cardiovascular causes.

Even in that study, though, a-fib risk rose among omega-3 users, by 35%.

Why has only one trial found heart benefits? Again, it's not yet clear, Dixon said

But, he added, Vascepa is different from the fish oil products tested in the other trials. It contains only one omega-3, called EPA, while the other products contain a combination of EPA and DHA."

I chose this quote to show use one that shows that this product is not "fish oil" but rather one isolated component of fish oil but their are similar comparisons through out.

Their are a lot of words like "may" and "suggests" littered in these writings but personally if one were to buy into what's being presented I'll take a 25% drop in risk of possibly deadly and definitely life changing cardiovascular events over a 35% rise in risk of what my cardiologist says is an extremely common condition that a lot of people have and don't even notice. Not to downplay it too much, it can be very serious at some point.

When I add the dramatic effect FO has had on my BP and all the other evidence of the CV benefits it's a no brainer to stay the course I'm on now.

Not a Dr, Not advice, just offering an opinion and hoping to encourage folks to go beyond the clickbait headlines and do some critical thinking.

"Follow the Science" has become a well used term in the last couple of years but what most people do is follow the headlines or at best follow what someone has offered up as their interpretation of the science which could be twisted for a plethora of reasons. I'd encourage digging deeper, learning more and coming to your own conclusions not those from someone with unknown motivations.

 

[Shute]

Benefits of fish oil likely outweigh risks for the majority of the population, but for someone like me with a.) a family history of inherited AFib despite high fitness levels b.) no family history of ASCVD c.) a history of slugging down gram after gram of FO daily for many years, being aware of this potential risk, even in a specific subset of the population, has given me pause.

AFib is awful. It gets worse nearly 100% of the time. Even if you're subclinical and have it, which are mainly seniors, it will eventually progress to paroxysmal, where you get attacks several times a week, and if untreated, permanent. Best options include a cardiac ablation procedure, where they thread a probe via catheter to either burn or freeze off the area of the heart that's causing the problems, but if often comes back in the future. The other route is lifelong beta blockers, anticoagulants and rhythm control medications. Neither is a great scenario and it's something you really want to steer clear of, especially with a family history and/or existing risk factors.

Does fish oil cause cardiac arrhythmia in high-risk individuals? - Peter Attia

Reports of increased risk of atrial fibrillation in high-risk patients taking fish oil

peterattiamd.com

Not sure if anyone follows Peter Attia, he runs in my opinion the best medical podcast out there and puts out some very high quality content. He employs a team of researchers to help distill some of the available data for different conditions. He's also not schilling anything as far as I can see, aside from signing up for the "subscriber only" tier of his website. The link above may be of interest to some of you as a high level overview of some the data out there for fish oil.

 

[gondar1]

Benefits of fish oil likely outweigh risks for the majority of the population, but for someone like me with a.) a family history of inherited AFib despite high fitness levels b.) no family history of ASCVD c.) a history of slugging down gram after gram of FO daily for many years, being aware of this potential risk, even in a specific subset of the population, has given me pause.

AFib is awful. It gets worse nearly 100% of the time. Even if you're subclinical and have it, which are mainly seniors, it will eventually progress to paroxysmal, where you get attacks several times a week, and if untreated, permanent. Best options include a cardiac ablation procedure, where they thread a probe via catheter to either burn or freeze off the area of the heart that's causing the problems, but if often comes back in the future. The other route is lifelong beta blockers, anticoagulants and rhythm control medications. Neither is a great scenario and it's something you really want to steer clear of, especially with a family history and/or existing risk factors.

Does fish oil cause cardiac arrhythmia in high-risk individuals? - Peter Attia

Reports of increased risk of atrial fibrillation in high-risk patients taking fish oil

peterattiamd.com

Not sure if anyone follows Peter Attia, he runs in my opinion the best medical podcast out there and puts out some very high quality content. He employs a team of researchers to help distill some of the available data for different conditions. He's also not schilling anything as far as I can see, aside from signing up for the "subscriber only" tier of his website. The link above may be of interest to some of you as a high level overview of some the data out there for fish oil.

I feel for you being burdened with what you've possibly inherited. With that knowledge I'd be watching any associated info closely too, I hope you do well. You raise valid points especially with regard to a specific person and situation which should always be the paramount consideration.

I do have to say that for the majority of people the article you linked to backs up what I said above and is specifically helpful in that it fills in some of the details about the problems I mentioned in my first post but didn't have time/energy to expand on. Things like some of the trials being based on people on statins and/or with elevated triglycerides and CVD. Also to the authors credit they do mention a bunch of conflicting findings from studies that were not part of the META. These discrepancies matter in such META's, sometimes to the point of making the conclusions reached much more of speculation based opinion (may, possibly, suggesting, could, etc ) than anything approaching conclusiveness. I feel that's the case here.

In fact from an objective point of view you could take what Dr Attia has said there as a kind of rebuttal to the opinions offered in the first two links in your OP.

I do hear his name pop up, I'll have to have a look at some of his content as he does seem to be on the ball so far.

 

[Freshional]

I have an anecdotal expierience with this. I will try to be as detailed as possible and respond if theres any follow up. Insight from others is appreciated.

About two months ago I ran out of omega3s. I was taking a daily dose of 4 omega3 tablets. They were the jamieson omega 3 selects(1000mg) that have EPA and DHA in them. I had planned to just start taking two daily as I found out more is not necessarily better and I had begun taking two.

Probably within a week of starting two daily I had to visit the ER to get my heart shocked back into rhythm as I was having atrial fibrillation. I have a history of random heart palpitations that seem to ebb and flow in severity over the years. My doctor chalks it up as stress and I blame the anxiety medication I have been on for 14 years.
I had palpitations before starting omega3 oil.

I had all the tests and everything after and two different cardiologists follow up. Heart is completely good no issues structurally or otherwise. Blood pressure good. Blood tests good. Ultrasound of heart good. Ekg good. My mother developed afib in her 60s so I might be pre disposed to it.

Both gave me the same answer as to what to do about afib which is nothing. They said I am too young for most treatments and being in afib given my health would only increase my risk of stroke by .5% so just sleep it off next time I get it.

Anyways, thats my own personal account of dealing with this issue. I am still in the camp of taking it daily to mitigate other issues but I am wary of it now.

Fresh

 

[Bigbear]

I have an anecdotal expierience with this. I will try to be as detailed as possible and respond if theres any follow up. Insight from others is appreciated.

About two months ago I ran out of omega3s. I was taking a daily dose of 4 omega3 tablets. They were the jamieson omega 3 selects(1000mg) that have EPA and DHA in them. I had planned to just start taking two daily as I found out more is not necessarily better and I had begun taking two.

Probably within a week of starting two daily I had to visit the ER to get my heart shocked back into rhythm as I was having atrial fibrillation. I have a history of random heart palpitations that seem to ebb and flow in severity over the years. My doctor chalks it up as stress and I blame the anxiety medication I have been on for 14 years.
I had palpitations before starting omega3 oil.

I had all the tests and everything after and two different cardiologists follow up. Heart is completely good no issues structurally or otherwise. Blood pressure good. Blood tests good. Ultrasound of heart good. Ekg good. My mother developed afib in her 60s so I might be pre disposed to it.

Both gave me the same answer as to what to do about afib which is nothing. They said I am too young for most treatments and being in afib given my health would only increase my risk of stroke by .5% so just sleep it off next time I get it.

Anyways, thats my own personal account of dealing with this issue. I am still in the camp of taking it daily to mitigate other issues but I am wary of it now.

Fresh

Couple questions, do you do gear and if so does this make I more dangerous for you and second, I think I read somewhere that arterial fib was mainly caused by dha and not epa making vasceepa a safer choice is this true and have your docs told you to avoid all fish oil?

 

[Freshional]

Couple questions, do you do gear and if so does this make I more dangerous for you and second, I think I read somewhere that arterial fib was mainly caused by dha and not epa making vasceepa a safer choice is this true and have your docs told you to avoid all fish oil?

I am on TRT at a small dose of 75mg of testcyp/week and .5mg of estriadol. One cardiologist didn't care so much the other wants me to see an endocrinologist to see if I truly need it as he claims I shouldn't be on it and says I am being exploited for money. He also said it's harmful for my heart but he gave me no specific indication it related to afib.

No doctor I have spoken with told me to stop taking the oil. We didn't discuss vasceepa nor do I have previous knowledge of it.