The effect of marine n-3 polyunsaturated fatty acids on cardiac autonomic and hemodynamic function in patients with psoriatic arthritis: a randomised, double-blind, placebo-controlled trial

Design: randomized, double-blind, placebo-controlled trial. Participants: adults with psoriatic arthritis; 145 enrolled (72 in n-3 PUFA group, 71 in placebo); mean age ~52 years; ~58% female. Inclusion: adults ≥18 with PsA; Exclusion: known cardiac arrhythmias or use of biological DMARDs or oral corticosteroids.

3 g/day marine omega-3 fatty acids (EPA and DHA 50/50) for 24 weeks, taken as six capsules daily.

Intention-to-treat after 24 weeks showed a non-significant trend toward higher RR intervals (p=0.06) and lower resting heart rate (p=0.12) with n-3 PUFA vs control. Per-protocol analysis (consuming >85% of supplements) showed significant increases in RR intervals (p=0.01) and reductions in heart rate (p=0.01) in the n-3 PUFA group vs controls. Blood pressure, central blood pressure and pulse wave velocity did not change. Granulocyte n-3 PUFA content increased; arachidonic acid and linoleic acid content decreased. Conclusion: marine n-3 PUFA may improve cardiac autonomic tone in PsA, indicating potential cardiovascular benefit; larger trials are needed to confirm translation to reduced cardiovascular disease risk.

Five-minute HRV assessment; nighttime autonomic function not assessed. Carotid-femoral PWV not used (gold standard). Population had low disease activity and many on DMARDs, limiting generalizability. Adherence differences affected ITT vs per-protocol analyses; olive oil placebo may have anti-inflammatory effects; duration may be insufficient to detect arterial stiffness changes.