Omega 3 and atrial fibrillation: Where are we?

Table 1 Clinical studies investigating the effect of n-3 poly-unsaturated fatty acids on primary prevention for atrial fibrillation

Study design	Population	PUFA administration	PUFA quantification	AF diagnosis	Results
Prospective cohort[5]	4815 individuals; age 72.8 yr; United States	Broiled/backed fish assessment. FU: 12 yr	FFQ	Annual ECG; hospital discharge diagnoses	Lower AF risk of 31% with fish intake ≥ 5 times/wk vs < 1/mo. P = 0.008
Prospective cohort[12]	2174 subjects; mean age: 52.8 yr; Finland	Serum EPA and DHA and dosage. FU: 17.7 yr	DHA, EPA serum dosage	National computerized hospitalization registry	Lower AF risk of 38% for higher DHA levels. P = 0.02
Prospective cohort[6]	3326 subjects; age: 74.1 yr; United States	Serum EPA, DHA dosage	DHA, EPA serum dosage	Annual ECG; telephonic contact 2/yr; hospitalizations	Lower AF risk for top vs lowest quartile of PUFA/ DHA levels
Population study[7]	3242 subjects affected by acute myocardial infarction; age: 54.1 yr; Italy	Previous PUFA intake vs not. FU: 360 d	FFQ	AF episodes during hospitalization	Lower risk of AF with fish oil
Prospective cohort[8]	47949 subjects; age: 46 yr; Denmark	Fish-oil intake assessment. FU: 5.7 yr	FFQ	Danish national hospitalization registry	Higher AF risk for top vs lowest quintiles of fish intake
Prospective cohort[9]	5184 subjects; age 67.4 yr; the Netherland	Fish-oil intake assessment. FU: 6.4 yr	FFQ	Two ECGs during FU; clinical data from general practitioners	No AF risk reduction in the highest tertile of fish intake
Prospective cohort[10]	44720 female; age: 63 yr; United States	Fish intake assessment. FU: 6 yr	FFQ	ECG at baseline and at the third and sixth years	No lower AF risk for higher fish intake
Prospective cohort[11]	4526 individuals; age: 62 yr; United States	Fish intake assessment. FU: 4 yr	FFQ	Two ECGs every 4 yr of FU; hospitalizations	No AF risk reduction in the top vs the lowest tertile of fish intake
Post-hoc analysis of a RCT (Aleksova)[13]	5835 systolic heart failure-subjects	N-3 PUFAs 1 g/d vs placebo; FU 3.9 yr	No PUFA dosage	ECG during FU visits	No AF risk reduction with n-3 PUFA

FU: Follow-up; FFQ: Food frequency questionnaires; AF: Atrial fibrillation; EPA: Eicosapentaenoic acid; DHA: Docosahexaenoic acid; RCT: Randomized controller trial; PUFA: Poly-unsaturated fatty acids.