From the Guidelines
Lovaza should be used with caution in patients with atrial fibrillation (AFib) as it may increase the risk of AFib, particularly at high doses. When considering the use of Lovaza in patients with AFib, it is essential to weigh the potential benefits of reducing triglyceride levels against the potential risk of worsening AFib. The most recent and highest quality study, published in 2024 in the journal Pharmacological Research 1, found that omega-3 fatty acids, including those found in Lovaza, increase the risk of AFib, with a higher risk associated with doses greater than 1g daily. Another study published in 2024 in the journal Arteriosclerosis, Thrombosis, and Vascular Biology 1, also found that high-dose omega-3 fatty acid supplementation was associated with a higher risk of new-onset AFib. Key points to consider when using Lovaza in patients with AFib include:
- Monitoring for signs and symptoms of AFib, such as palpitations, shortness of breath, and fatigue
- Regularly reviewing electrocardiogram (ECG) results to assess for AFib
- Adjusting the dose of Lovaza or discontinuing it if AFib worsens or if the patient experiences any adverse effects
- Considering alternative treatments for reducing triglyceride levels that may have a lower risk of worsening AFib. It is crucial to consult with a healthcare provider before starting Lovaza, especially for patients with AFib or other cardiac conditions, to determine the best course of treatment and to monitor for any potential adverse effects 1.
From the FDA Drug Label
In a double-blind, placebo-controlled trial of 663 subjects with symptomatic paroxysmal AF (n = 542) or persistent AF (n = 121), recurrent AF or flutter was observed in subjects randomized to LOVAZA who received 8 grams per day for 7 days and 4 grams per day thereafter for 23 weeks at a higher rate relative to placebo Although the clinical significance of these results is uncertain, there is a possible association between LOVAZA and more frequent recurrences of symptomatic atrial fibrillation or flutter in patients with paroxysmal or persistent atrial fibrillation, particularly within the first 2 to 3 months of initiating therapy.
Lovaza and AFib: There is a possible association between Lovaza and more frequent recurrences of symptomatic atrial fibrillation or flutter in patients with paroxysmal or persistent atrial fibrillation, particularly within the first 2 to 3 months of initiating therapy 2.
- Key points:
- Lovaza may increase the risk of recurrent AFib or flutter
- The clinical significance of this association is uncertain
- Patients with paroxysmal or persistent AFib should be monitored closely when initiating Lovaza therapy 2
From the Research
Lovaza and Atrial Fibrillation
- Lovaza, an omega-3 fatty acid supplement, has been studied in relation to atrial fibrillation (AF) in several clinical trials 3, 4.
- The evidence suggests that omega-3 fatty acid treatment may be associated with an increased risk of AF, with a significant association noted between n-3 FA treatment and risk of AF (RR 1.24,95% CI 1.11-1.38, p = 0.0002) 4.
- The risk of AF may be dose-dependent, with higher doses of n-3 FA (> 1 g daily) showing a stronger association with AF risk (RR 1.51,95% CI 1.26-1.80, p < 0.001) compared to lower doses (≤ 1 g daily) (RR 1.12,95% CI 1.04-1.21, p = 0.004) 4.
- However, it is essential to note that the overall AF event rates were low, and n-3 FA treatment did not increase the risk of stroke (RR 1.04,95% CI 0.90-1.20) 4.
Exercise and Atrial Fibrillation
- Exercise training has been shown to improve exercise capacity, quality of life, and symptoms associated with AF 5, 6, 7.
- A systematic review and meta-analysis found that physical exercise improved quality of life, exercise ability, and cardiopulmonary fitness in patients with AF, with whole-body aerobic exercise recommended 6.
- Another systematic review and literature analysis documented significant improvements in 6-minute walking test distance, peak oxygen uptake, and quality of life with exercise training, with high adherence to training and no serious adverse events 7.
Lovaza and Exercise in Atrial Fibrillation
- There is no direct evidence on the combined effect of Lovaza and exercise on AF.
- However, considering the potential benefits of exercise on AF symptoms and the possible increased risk of AF with omega-3 fatty acid treatment, patients with AF should consult their healthcare provider before starting Lovaza or any exercise program 5, 6, 3, 4, 7.