In a recent study published in Heart Rhythm, researchers evaluated temporal associations between energy drink consumption and the risk of cardiac events among patients with genetic heart diseases (GHDs).
Study: Sudden cardiac arrest occurring in temporal proximity to consumption of energy drinks. Image Credit: Petro Artem/Shutterstock.com
Background
The energy drink market has consistently grown in the United States (US). Most beverages claim to have natural ingredients, which are classified as dietary supplements.
As such, the Food and Drug Administration (FDA) monitoring of these products/manufacturers is not required. Energy drinks contain caffeine and other stimulants, such as guarana and taurine, that the FDA does not regulate. This raises concerns about the cumulative effects of caffeine and unregulated ingredients.
Studies have suggested a potential correlation between high caffeine intake and sudden cardiac arrests (SCAs). GHD patients already exhibit a higher SCA risk.
The increase in energy drinks’ popularity, higher caffeine content, and the presence of unregulated ingredients raise concerns about their use in GHD patients.
The study and findings
The present study investigated whether a potential temporal relationship exists between energy drink intake and cardiac events among GHD patients.
They reviewed over 5,000 patients evaluated at the Mayo Clinic between 2000 and 2023 to identify SCA survivors. Among SCA survivors, the team identified those with a sentinel or breakthrough cardiac (BCE) event in temporal proximity to energy drink consumption.
Sentinel events occurred pre-diagnosis, whereas BCEs occurred after event diagnosis and treatment initiation. Medical records were accessed for data on demographics, clinical characteristics, energy drink consumption, and its temporal relationship with SCA. Overall, 144 SCA survivors were identified; 73 were female.
Seven patients, including six females, had a temporal relation between SCA and energy drink consumption. SCA was a sentinel event in six patients and a BCE in one patient. Further, three of these patients were diagnosed with SCA/idiopathic ventricular fibrillation (IVF).
Long QT syndrome (LQTS) was diagnosed in two patients, and catecholaminergic polymorphic ventricular tachycardia (CPVT) in the remaining two.
Energy drink consumption was frequent in three patients and infrequent in four. The time between energy drink intake and an event varied from immediately preceding the event to within 12 hours.
Different energy drinks were consumed, and their caffeine content ranged between 80 mg and > 200 mg per serving. One patient required manual resuscitation, and six required a rescue shock.
Six patients were discharged with an implanted cardioverter-defibrillator (ICD); two were discharged on pharmacological therapy, and two underwent left cardiac sympathetic denervation (LCSD). All subjects ceased energy drink consumption post-SCA and have since remained BCE-free during a mean follow-up of 52 months.
The first patient was a female aged 32 who was 11 weeks postpartum before the event. After working out, the individual consumed an energy drink and experienced an SCA a few hours later, requiring defibrillation.
The patient was diagnosed with IVF and discharged with subcutaneous ICD. The second case was a female aged 37 who had a sentinel event a few hours after consuming the energy drink and received a shock from first responders.
The patient was diagnosed with IVF and discharged with ICD and nadolol. The third case was a male aged 20 who regularly consumed energy drinks before working out.
The patient collapsed while sprinting during practice and received two automatic external defibrillator (AED) shocks. The patient was diagnosed with IVF and received an ICD.
The fourth case, a 28-year-old female experienced the sentinel event after consuming a large quantity of energy drink and collapsed suddenly, requiring an AED shock.
The patient was discharged on beta-blocker therapy and with a pacemaker defibrillator. Genetic tests led to CPVT diagnosis after the detection of a ryanodine receptor 2 (RYR2) variant.
The fifth case was a 21-year-old female. The sentinel event was syncope at age 7. Genetic tests revealed RYR2-mediated CPVT. The patient had an SCA while being treatment-compliant for ten years, with an ICD implanted.
Another SCA occurred three years later after consuming an energy drink. The patient collapsed at the workplace and, required three AED shocks, and has since not experienced any BCE.
Conclusions
The study described seven cases of GHD patients who experienced an SCA in temporal proximity to energy drink consumption. Most cases were not frequent consumers of energy drinks. Only one patient had a previous GHD and was on treatment.
While a temporal relationship appeared between the SCA event and energy drink consumption, several events occurred among potential agitators that may have contributed.
Notably, the study was performed at a single center with a small cohort, warranting caution for conclusions on the direct effects of energy drinks on GHD patients.
Taken together, the researchers observed that 5% of SCA survivors had consumed at least one energy drink before their event. Therefore, patients should limit their energy drink consumption, and the FDA should provide guidelines on the safe and proper use of energy drinks.