Omega-3 Fatty Acid Biomarkers and Incident Atrial Fibrillation

Frank Qian; Nathan Tintle; Paul N Jensen; Rozenn N Lemaitre; Fumiaki Imamura; Tobias Rudholm Feldreich; Sarah Oppeneer Nomura; Weihua Guan; Federica Laguzzi; Eunjung Kim; Jyrki K Virtanen; Marinka Steur; Christian S Bork; Yoichiro Hirakawa; Michelle L O'Donoghue; Aleix Sala-Vila; Andres V Ardisson Korat; Qi Sun; Eric B Rimm; Bruce M Psaty; Susan R Heckbert; Nita G Forouhi; Nicholas J Wareham; Matti Marklund; Ulf Risérus; Lars Lind; Johan Ärnlöv; Parveen Garg; Michael Y Tsai; James Pankow; Jeffrey R Misialek; Bruna Gigante; Karin Leander; Julie A Pester; Christine M Albert; Maryam Kavousi; Arfan Ikram; Trudy Voortman; Erik B Schmidt; Toshiharu Ninomiya; David A Morrow; Antoni Bayés-Genís; James H O'Keefe; Kwok Leung Ong; Jason H Y Wu; Dariush Mozaffarian; William S Harris; David S Siscovick; Fatty Acids and Outcomes Research Consortium (FORCE)

doi:10.1016/j.jacc.2023.05.024

Omega-3 Fatty Acid Biomarkers and Incident Atrial Fibrillation

J Am Coll Cardiol. 2023 Jul 25;82(4):336-349. doi: 10.1016/j.jacc.2023.05.024.

Authors

Frank Qian¹, Nathan Tintle², Paul N Jensen³, Rozenn N Lemaitre³, Fumiaki Imamura⁴, Tobias Rudholm Feldreich⁵, Sarah Oppeneer Nomura⁶, Weihua Guan⁷, Federica Laguzzi⁸, Eunjung Kim⁹, Jyrki K Virtanen¹⁰, Marinka Steur¹¹, Christian S Bork¹², Yoichiro Hirakawa¹³, Michelle L O'Donoghue¹⁴, Aleix Sala-Vila¹⁵, Andres V Ardisson Korat¹⁶, Qi Sun¹⁷, Eric B Rimm¹⁸, Bruce M Psaty¹⁹, Susan R Heckbert²⁰, Nita G Forouhi⁴, Nicholas J Wareham⁴, Matti Marklund²¹, Ulf Risérus²², Lars Lind²³, Johan Ärnlöv²⁴, Parveen Garg²⁵, Michael Y Tsai⁶, James Pankow²⁶, Jeffrey R Misialek²⁶, Bruna Gigante²⁷, Karin Leander⁸, Julie A Pester²⁸, Christine M Albert²⁹, Maryam Kavousi¹¹, Arfan Ikram¹¹, Trudy Voortman³⁰, Erik B Schmidt³¹, Toshiharu Ninomiya³², David A Morrow¹⁴, Antoni Bayés-Genís³³, James H O'Keefe³⁴, Kwok Leung Ong³⁵, Jason H Y Wu³⁶, Dariush Mozaffarian³⁷, William S Harris³⁸, David S Siscovick³⁹; Fatty Acids and Outcomes Research Consortium (FORCE)

Affiliations

¹ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
² Department of Mathematics and Statistics, Dordt University, Sioux Center, Iowa, USA; Fatty Acid Research Institute, Sioux Falls, South Dakota, USA.
³ Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, USA.
⁴ MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
⁵ School of Health and Social Sciences, Dalarna University, Falun, Sweden; Center for Clinical Research Dalarna, Region Dalarna, Falun, Sweden.
⁶ Department of Lab Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA.
⁷ Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA.
⁸ Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
⁹ Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
¹⁰ Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
¹¹ Department of Epidemiology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands.
¹² Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
¹³ Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
¹⁴ TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
¹⁵ Fatty Acid Research Institute, Sioux Falls, South Dakota, USA; Cardiovascular Risk and Nutrition - Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain.
¹⁶ Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA.
¹⁷ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
¹⁸ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
¹⁹ Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Systems and Population Health, University of Washington, Seattle, Washington, USA.
²⁰ Cardiovascular Health Research Unit, Department of Epidemiology, University of Washington, Seattle, Washington, USA.
²¹ Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden; Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
²² Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
²³ Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
²⁴ Center for Clinical Research Dalarna, Region Dalarna, Falun, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden; Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Stockholm, Sweden.
²⁵ Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, California, USA.
²⁶ Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
²⁷ Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
²⁸ Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
²⁹ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
³⁰ Department of Epidemiology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands; Division of Human Nutrition and Health, Wageningen University and Research, Wageningenn, the Netherlands.
³¹ Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
³² Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
³³ Department of Cardiology, Heart Institute, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
³⁴ Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA.
³⁵ NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
³⁶ The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
³⁷ Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA; Division of Cardiology, Tufts Medical Center, Boston, Massachusetts, USA.
³⁸ Fatty Acid Research Institute, Sioux Falls, South Dakota, USA; Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota, USA.
³⁹ The New York Academy of Medicine, New York, New York, USA. Electronic address: dsiscovick@nyam.org.

PMID: 37468189
DOI: 10.1016/j.jacc.2023.05.024

Abstract

Background: The relationship between omega-3 fatty acids and atrial fibrillation (AF) remains controversial.

Objectives: This study aimed to determine the prospective associations of blood or adipose tissue levels of eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) with incident AF.

Methods: We used participant-level data from a global consortium of 17 prospective cohort studies, each with baseline data on blood or adipose tissue omega-3 fatty acid levels and AF outcomes. Each participating study conducted a de novo analyses using a prespecified analytical plan with harmonized definitions for exposures, outcome, covariates, and subgroups. Associations were pooled using inverse-variance weighted meta-analysis.

Results: Among 54,799 participants from 17 cohorts, 7,720 incident cases of AF were ascertained after a median 13.3 years of follow-up. In multivariable analysis, EPA levels were not associated with incident AF, HR per interquintile range (ie, the difference between the 90th and 10th percentiles) was 1.00 (95% CI: 0.95-1.05). HRs for higher levels of DPA, DHA, and EPA+DHA, were 0.89 (95% CI: 0.83-0.95), 0.90 (95% CI: 0.85-0.96), and 0.93 (95% CI: 0.87-0.99), respectively.

Conclusions: In vivo levels of omega-3 fatty acids including EPA, DPA, DHA, and EPA+DHA were not associated with increased risk of incident AF. Our data suggest the safety of habitual dietary intakes of omega-3 fatty acids with respect to AF risk. Coupled with the known benefits of these fatty acids in the prevention of adverse coronary events, our study suggests that current dietary guidelines recommending fish/omega-3 fatty acid consumption can be maintained.

Keywords: biomarkers; docosahexaenoic acid; docosapentaenoic acid; eicosapentaenoic acid; observational epidemiology.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / epidemiology
Biomarkers
Docosahexaenoic Acids
Eicosapentaenoic Acid
Fatty Acids, Omega-3*
Humans
Prospective Studies
Risk Factors

Substances

Biomarkers
Docosahexaenoic Acids
Eicosapentaenoic Acid
Fatty Acids, Omega-3

Abstract

Publication types

MeSH terms

Substances

Grants and funding