Energy Drink Consumption Affecting Cardiac Health?

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Energy drink consumers should be advised to use energy drinks in moderation, and consider drinking caffeine drinks without added ingredients.
Energy drink consumers should be advised to use energy drinks in moderation, and consider drinking caffeine drinks without added ingredients.

I recall getting a call from the emergency department (ED) several years ago about a young man in his early 30s presenting with typical angina at rest. A quick glance at his electrocardiogram (ECG) revealed an ST-elevation myocardial infarction (STEMI), and his troponins exceeded 35 ng/mL. 

I took him straight to the catheterization lab, where he was found to have a sticky thrombus occluding the left anterior descending artery, but no other significant coronary artery disease. I remember going back and asking him questions to figure out why a 30-something-year-old was having a myocardial infarction.

He wasn't a smoker, had no family history of coronary artery disease, and had no risk factors. The only thing that stood out at the time was that he was an avid drinker of energy drinks. He had gulped down a couple off-brand energy drinks filled with unrecognizable ingredients and lots of vitamin B6, vitamin B12, and caffeine. 

The case was anecdotal, at best, and when I brought up the possibility of an acute thrombus induced by an energy drink, my attendings were not the least bit interested. A couple years later, I ran into a case where a group of college students were up late partying and had decided to challenge each other to see who could drink the most energy drinks.

Apparently, they all fell sick that night as a result, but 1 of them began to have severe substernal chest pressure typical of angina. In the ED, he was found to have significant ST elevations and was taken to the catheterization lab, where he was found to have significant clot burden occluding all his coronary arteries. He required urgent coronary artery bypass surgery.

Apparently, I wasn't the only one noticing this surge in myocardial infarctions in young individuals and an association with caffeinated beverages. In 2011, Martin Scott published a case report in the British Medical Journal of a 19-year-old man with no significant prior history, other than mild gastroesophageal disease, who presented with chest pain and was found to have a STEMI, according to the ECG and biomarkers. A closer look revealed that, in the week before his admission, he had been consuming large quantities of an energy drink. The authors argued that these energy drinks may have contributed to his presentation.1

In 2013, Nihat Polat reported a case of a 13-year-old boy who presented with an acute STEMI shortly after consuming an energy drink. During catheterization, he was found to have spontaneous coronary artery dissection, which in and of itself is a rare cause of sudden cardiac death, let alone in children.2

More recently, this year, Emily Fletcher and colleagues performed a randomized controlled trial to test whether the consumption of energy drinks was associated with adverse ECG and blood pressure abnormalities when compared with caffeine alone. 

The researchers' premise was that the additional ingredients in energy drinks may contribute to previously reported adverse cardiovascular events, including abnormal heart rhythms, ST segment elevation, and QT prolongation.3 They found that the QTc interval on ECG was significantly prolonged by about 10 ms, 2 hours after high-volume energy drink consumption, when compared with caffeine alone. When the researchers tested the energy drinks in a non-controlled setting, they found that 57% of the participants had a QTc >500 ms 2 hours after consumption of 2 cans of the energy drink used in the study.3

The findings are alarming for the same reasons they were discussed in that paper; namely, several non-cardiovascular drugs have been pulled from US markets by the US Food and Drug Administration (FDA) because of 5 to 10 ms QTc interval prolongation. The FDA requires thorough investigation of any drug that prolongs the QTc more than 10 ms, yet the often bizarre proprietary blends found in many energy drinks fly under the radar.

The overall safety of energy drinks remains unknown, but there is a growing number of case reports of young individuals developing serious and adverse cardiovascular consequences after large doses of consumption. More recent trial data suggest adverse ECG changes may occur after high-volume energy drink consumption and should prompt further investigation by the FDA.

Consumers of energy drinks should use some caution moving forward. Most of these cases have been associated with drinking a large volume of energy drinks, and thus, individuals who regularly consume energy drinks should be advised to use them in moderation. For a quick "pick-me-up" during the day, consider what we do in Miami and have a cortadito, a delightful espresso drink that includes only water, caffeine, sugar, and a splash of milk.

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References

  1. Scott M, El-Hassan M, and Khan A. Myocardial infarction in a young adult following the consumption of a caffeinated energy drink [published online June 29, 2011]. BMJ Case Reports. doi: 10.1136/bcr.02.2011.3854
  2. Polat N, Ardıç I, Akkoyun M, Vuruşkan E. Spontaneous coronary artery dissection in a healthy adolescent following consumption of caffeinated "energy drinks." Turk Kardiyol Dern Ars. 2013;41(8):738-742. doi: 10.5543/tkda.2013.37542
  3. Fletcher EA, Lacey CS, Aaron M, Kolasa M, Occiano A, Shah SA. Randomized controlled trial of high-volume energy drink versus caffeine consumption on ECG and hemodynamic parameters [published online April 26, 2017]. JAHA. doi: 10.1161/JAHA.116.004448
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