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Meta-analysis reaffirms protective effect of preoperative omega-3 fatty acids against postoperative atrial fibrillation

Meta-analysis reaffirms protective effect of preoperative omega-3 fatty acids against postoperative atrial fibrillation

Friday, May 10, 2013. The results of an updated meta-analysis published online on April 12, 2013 in the Journal of Thoracic and Cardiovascular Surgery indicate that preoperative supplementation with omega-3 polyunsaturated fatty acids provides significant protection against atrial fibrillation in open heart surgery patients. Atrial fibrillation is the most common type of heart arrhythmia that occurs after heart surgery, and can result in longer hospitalization and an increase risk of postoperative mortality.

"Current guidelines recommend the use of antiarrhythmic drugs to decrease the risk of postoperative atrial fibrillation after cardiac surgery," authors Simona Costanzo and her colleagues at Italy's Univerisita Cattolica write. "However, the patient is not fully protected from postoperative atrial fibrillation by using only these agents; thus, newer therapies (nonantiarrhythmic drugs) for the management of atrial fibrillation are needed to be used in combination with them."

The analysis included eight randomized clinical trials evaluating the efficacy of omega-3 fatty acids for the prevention of atrial fibrillation following coronary artery bypass graft surgery and/or heart valve surgery in 2,687 men and women. A total of 398 atrial fibrillation events were documented postoperatively. Among subjects who received omega-3 fatty acids, there was a 16% lower risk of atrial fibrillation in comparison with those who received a placebo. When the analysis was limited to coronary artery bypass graft surgery patients, the reduction in risk associated with omega-3 supplementation increased to 34%.

In their discussion of the findings, the authors remark that factors associated with atrial fibrillation include advanced age, diabetes, and intraoperative and other factors, and that the common pathways of all of these factors involve inflammation and oxidative stress. The benefit of omega-3 fatty acids in preventing postoperative atrial fibrillation could be due to their anti-inflammatory property or a direct antiarrhythmic effect.

The authors suggest that preoperative omega-3 fatty acid supplementation should be tested in future studies of patients undergoing a single type of heart surgery procedure.

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High omega-3 levels show protective effect against sudden cardiac death among dialysis patients

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In an article that appeared online on February 6, 2013 in the journal Kidney International, researchers from Indiana University School of Medicine in collaboration with scientists from Massachusetts General Hospital report an association between higher levels of long-chain omega-3 fatty acids in early kidney dialysis patients and a reduced risk of sudden cardiac death, the leading cause of mortality in this group.

Allon N. Friedman, MD and his colleagues compared omega-3 blood levels of 100 patients who underwent sudden cardiac death within the first year of dialysis to levels measured among 300 survivors. A declining risk of death was observed in association with increasing levels of omega-3 fatty acids, with those whose levels were among the top 25 percent of subjects having an 80 percent lower risk than those whose levels were lowest.

"We found that higher levels of omega-3 fatty acids in the blood of patients who were just starting hemodialysis were very strongly associated with a lower risk of sudden cardiac death over the first year of their treatment," stated Dr Friedman, who is an associate professor of medicine at the Indiana University School of Medicine's Division of Nephrology.

"The risk of sudden cardiac death in hemodialysis patients is highest during the first year of treatment," he noted. "The annual rate of sudden cardiac death is about 6 to 7 percent, which may even exceed the rate in patients with heart failure. This study is a first step toward identifying a possible treatment for sudden cardiac death in dialysis patients."

"Because omega-3 fatty acids can be obtained from certain foods, such as fish oil, our findings also have important implications for the type of diet we recommend to patients on dialysis," he added.

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