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. 2024;24(6):651-663.
doi: 10.2174/0118715303280825231122153024.

Eicosapentaenoic Acid: between Cardiovascular Benefits and the Risk of Atrial Fibrillation

Filippo Egalini  1 , Mattia Rossi  1 , Mauro Massussi  2 , Giulia Gaggero  1 , Guglielmo Beccuti  1 , Andrea Benso  1 , Massimo F Piepoli  3   4 , Fabio Broglio  1
Affiliations

Eicosapentaenoic Acid: between Cardiovascular Benefits and the Risk of Atrial Fibrillation

Filippo Egalini et al. Endocr Metab Immune Disord Drug Targets. 2024.

Abstract

In recent years, scientific research has increasingly focused on the cardiovascular benefits of omega-3 polyunsaturated fatty acids (n-3 PUFAs) supplements. The most promising results emerged from the new trials on a high-dose eicosapentaenoic acid (EPA)-only approach, instead of the previously prescribed therapy with EPA + docosahexaenoic acid (DHA). The evidence of the reduction of cardiovascular events in patients at high cardiovascular risk with EPA is intriguing. However, physicians have expressed concern about the potential high risk of atrial fibrillation (AF) occurrence due to such an approach. This study aims to investigate the current evidence on the cardiovascular benefits of EPA and its association with atrial arrhythmogenesis. Current guidelines consider EPA (as IPE) treatment for selected patients but with no specific indication regarding AF risk evaluation. We propose a flowchart that could be a starting point for the future development of an algorithm to help clinicians to prescribe EPA safely and effectively, especially in patients at high risk of incipient AF.

Keywords: Atrial fibrillation; EPA.; cardiovascular events; eicosapentaenoic acid; n-3 PUFA; omega-3.

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Conflict of interest statement

The authors declare no conflict of interest, financial or otherwise.

Figures

Fig. (1)
Fig. (1)
Possible mechanisms of benefits and harms of n-3PUFAs on atrial arrhythmogenesis (A) and the newly discovered role of EPA on PIEZO1 ion channel (B).
Fig. (2)
Fig. (2)
A flowchart to guide EPA prescription, considering AF risk. EPA: Eicosapentaenoic acid, ASCVD: atherosclerotic cardiovascular disease, CVRF: cardiovascular risk factor, AF: atrial fibrillation, 4 gr/day (high-dose regimen), according to the current guidelines § Despite maximally tolerated statin treatment.
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