Some studies of fish oil supplements have shown a higher risk for atrial fibrillation with marine omega-3 fatty acids. Is it real? What are the implications for patients taking these capsules?
What about causality? Factors supporting causality include plausibility, consistency of increased AF risk in multiple studies, and a dose-response relationship.The first is the power of the randomized trial to inform practice. If we relied only on observational evidence, we might have assumed that since high fish consumption in populations associated with lower rates of cardiac events, fish oil supplementation would also reduce cardiac events.
Another underappreciated lesson is the notion that drugs, including supplements, can have off-target effects.
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