Dr. Bill Harris comments on omega-3 and atrial fibrillation
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Recent large-scale trials have shown a slight increase in atrial fibrillation for high-dose omega-3 supplementation. In this clip, Dr. Bill Harris highlights the many unknowns surrounding high omega-3 intake and atrial fibrillation. He discusses his surprise that omega-3 supplementation, which has been shown to reduce stroke risk — a clinical outcome of concern when it comes to atrial fibrillation — would be associated with it at all.
Dr. Patrick: One last question about safety, and this was something that was found as a, I guess you call an adverse side effect in the clinical trials. I believe it was both in the REDUCE-IT and STRENGTH where there was a small, but...
Dr. Harris: Statistically significant.
Dr. Patrick: Yeah. Significant increase in atrial fibrillation, AFib. And this was in people that already had pre-existing heart conditions.
Dr. Harris: Right, right, right. Yeah. And then they looked in VITAL and there was a slight increase, but not statistically significant in AFib. And that was the lower dose, it was 800 milligrams instead of 4,000 milligrams. So, yeah. This has not been settled, what's causing this. And I haven't got any magic answer either. Talked to cardiologists about it and they go, "I don't know." Wasn't seen for 20 years, 25 years of randomized trials. Nobody saw it. So why in these studies, two of them, 4-gram doses so that...and that could be...it could be that you want to be careful to give omega-3. If you're giving that high a dose to people, you might want to be a little more attentive to AFib. But there was no increased risk for stroke. There's actually decreased risk for stroke, which would be the clinical outcome of AFib of that.
But having AFib itself is not fun and having to take warfarin or other blood thinners chronically for your AFib because you've got AFib is not fun. So it's a reasonable thing to worry about and to look into and figure out. In our coalition of studies, our 1720 cohorts, we're looking at the question of incident AFib as a function of baseline omega-3 levels. Did people who had the highest omega-3 when followed out over years, are they more likely to develop AFib or not? So we don't know yet. We're looking at that.
Dr. Patrick: And how common is it in Japan? Do you know?
Dr. Harris: I don't. I don't know. Two studies have been published already looking at that question. We're looking at two individual cohorts that followed people out and said higher omega-3 at baseline lower risk for AFib. So it's not 4 grams a day. So maybe that's it. We'll see.
We did one big study where we were doing open-heart surgery on people trying to preload them with omega-3 before open-heart surgery.
This was a Dr. Mozaffarian OPERA study. And we're trying to prevent post-op AFib by giving them a big load of omega-3 ahead of time, because that was the theory at that time, that we could prevent atrial fibrillation in people by giving them omega-3 before surgery. And while it didn't work, it didn't make any difference. But we found that even if you give people for like 3 or 4 days 10 grams of omega-3 a day before surgery, they actually, when they checked how much bleeding, came on with the surgery, how much post-op bleeding was there was actually less post-op bleeding with the people that got the omega-3 than the placebo. Less need for transfusion, which was kind of cool. I mean, that is...not that we would advocate it for reducing risks for bleeding, but it's not increasing risk for bleeding.
A type of heart arrhythmia. Atrial fibrillation, also known as A-fib, is characterized by a rapid, irregular heartbeat. It occurs when the electrical signals that regulate blood flow between the upper and lower chambers of the heart become dysregulated. It is the most common form of heart arrhythmia.
A type of polyunsaturated fat that is essential for human health. Omega-3 fatty acids influence cell membrane integrity and affect the function of membrane-bound cellular receptors. They participate in pathways involved in the biosynthesis of hormones that regulate blood clotting, contraction and relaxation of artery walls, and inflammation. They have been shown to help prevent heart disease and stroke, may help control lupus, eczema, and rheumatoid arthritis, and may play protective roles in cancer and other conditions. Omega-3 fatty acids include alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). ALA is found mainly in plant oils such as flaxseed, soybean, and canola oils. DHA and EPA are found in fish and other seafood. The human body can convert some ALA into EPA and then to DHA, but the efficiency of the process varies between individuals.
An anticoagulant drug, commonly sold as Coumadin. Warfarin is used to prevent blood clots from forming or growing larger in the blood and blood vessels. It works by inhibiting vitamin K-dependent coagulation factors. Warfarin is prescribed for people who have experienced or are at risk of experiencing atrial fibrillation, cardiac valve replacement, or myocardial infarction (heart attack). Warfarin is also used to treat or prevent venous thrombosis (swelling and blood clot in a vein) and pulmonary embolism (a blood clot in the lung). Warfarin is in a class of medications called anticoagulants, often commonly referred to as "blood thinners."
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