Energy Drinks Tied to QTc Prolongation

Energy Drinks Tied to QTc Prolongation Posted By:
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Consuming caffeinated energy drinks is associated with QTc interval prolongation, which is a risk factor for torsades de pointes, according to a small study in the Journal of the American Heart Association. In recent years, energy drinks have come under fire for potentially serious effects on the heart—specifically when it comes to arrhythmias, increased blood pressure, and even cardiac arrest. Energy drink consumption has also been associated with spontaneous coronary dissection and coronary vasospasm. This association is strengthened with studies showing increased platelet aggregation. With the accessibility of energy drinks in every market/venue, understanding how these drinks affect the heart is extremely important to medical providers.

Thirty-four healthy adults aged 18 to 40 were assigned to consume two different commercially available energy drinks and a placebo drink. Both drinks used in the study contained between 304 and 320 milligrams of caffeine per 32 fluid ounces, yet previous research has shown that doses below 400 don't tend to cause any electrocardiographic changes. The beverages also contained ingredients such as taurine and B vitamins. Taurine is an amino acid that occurs naturally within the body and has actually been found to have antiarrhythmic properties, while B vitamins are also considered to be safe. Participants drank each 32-oz beverage over 60 minutes on 3 separate days, in randomized order. They were then monitored by ECG over 4 hours.

The maximum placebo-adjusted increase in QTc was 6.1 ms and 7.7 ms for each energy drink. In addition, systolic blood pressure was about 5 mm Hg higher after energy drink versus placebo consumption. The authors conclude, "Individuals with acquired or congenital long QT syndrome and those with hypertension should be more vigilant and limit their energy drink intake. Based on currently available data, the class of energy drinks, rather than one particular product, warrants use with caution."

Thus, if your patient has a history of cardiac problems, they could be increasing their risk of acute myocardial infarction/sudden death if they constantly consume energy drinks. The American Heart Association considers the safe consumption of caffeine for adults with healthy hearts at about 400 milligrams per day. However, if you consider that one energy drink can contain up to 300 milligrams of caffeine per can, guzzling multiple cans (as most people do) can amplify that risk.

References
  • AIM Market Insight. Global energy drinks market: insights, market size, share, growth, trends analysis and forecast to 2021. www.researchandmarkets.com/research/mbbjvv/global_energy. Accessed December 20, 2017.
  • Bailey RL, Saldanha LG, Dwyer JT. Estimating caffeine intake from energy drinks and dietary supplements in the United States. Nutr Rev. 2014;72(Suppl 1):9-13.
  • Grasser EK, Yepuri G, Dulloo AG, Montani JP. Cardio- and cerebrovascular responses to the energy drink Red Bull in young adults: a randomized cross-over study. Eur J Nutr. 2014;53:1561-1571.
  • Svatikova A, Covassin N, Somers KR, et al. A randomized trial of cardiovascular responses to energy drink consumption in healthy adults. JAMA. 2015;314:2079-2082.
  • Winniford MD. Energy drinks: another cause of QT prolongation? J Am Heart Assoc. 2019;8:e012833.

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Filed under: Cardiometabolic

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