Energy drinks, arrhythmias and cardiac arrest: who should not consume them

The energy drink market does not stop growing. They are consumed more and more and from an early age (even before finishing primary school). They are in the refrigerators of kiosks, club buffets, bowling alleys. Those who consume them can take them to better “endure” a night of studying, long work days, before doing physical exercise or mixed with alcohol. Sometimes, without any purpose, just for pleasure. Cardiologists have long warned about their potential heart risks and now a new study adds more evidence in that sense.

Published in the magazine Heart Rhythmthe work led by researchers at the Mayo Clinic (Rochester, United States), evaluated the records of 144 patients with proven arrhythmias who had survived sudden cardiac arrest, and observed that 7 of them (5% of the sample) had consumed one or more energy drinks shortly before the event occurred.

Coincidence or causality?

Although the study cannot demonstrate a relationship cause (drink energy drink)effect (suffer sudden cardiac arrest), the authors of the article suggest caution in the consumption of these products.

“Overall, 5% of sudden cardiac arrest survivors experienced it around the time of consuming an energy drink. Although larger studies are needed to elucidate the incidence/prevalence and quantify their precise risk, it seems prudent issue an early warning about this potential risk,” concluded the team led by Michael J. Ackerman, director of the Sudden Death Genomics Laboratory at the Mayo Clinic.

For Luis Aguinaga, cardiologist specialist in the study of arrhythmias (electrophysiology), former president of the Argentine Federation of Cardiology (FAC), the article “it’s very interesting”.

“This is not the first time that it has been reported that an energy drink can be associated with cardiac arrhythmias, but specifically in patients who already have electrical heart disease (like those studied in this publication), the authors observed that this underlying condition can be revealed or increased with these stimulants,” he explained.

Stimulating ingredients

The main ingredients of energy drinks are caffeine, taurine, guaranal -carnitine, B vitamins, sorbic acid, benzoic acid, glycine, ginseng, inositol, sucralose, maltodextrin and other sugars.

“Caffeine is very similar to a substance that we use medically to test these patients, which is norepinephrine. This test helps to discover, for example, alterations in ion channels, such as prolonged QT, tachycardia catecholaminergic, which are cause of sudden death, especially in young people, not only athletes. The problem with energy drinks is that the quantities supplied of each component are not regulated,” Aguinaga analyzed.

Since energy or energy drinks are registered as dietary supplements and not as medications, they are not required to go through the control of the US Food and Drug Administration (FDA).

In Argentina, they are cataloged in the same way and, therefore, they are not controlled by ANMAT, nor are they covered by the front labeling of foods, which excludes daily supplements. However, it is established that carry legends warning that they contain caffeine and that its intake is not recommended for children.

Previous studies had already shown a possible correlation between high caffeine consumption (compatible with the intake of more than 10 cups of coffee per day) and sudden or sudden cardiac arrest. Highly stimulant ingredients have also been reported to alter heart rate, blood pressure, cardiac contractility, and cardiac repolarization in a manner potentially proarrhythmicadded the authors.

The risk of cardiac arrest and/or sudden death is higher in those with genetic heart disease -they warned-, especially those with long QT syndrome, catecholaminergic polymorphic ventricular tachycardia and idiopathic ventricular fibrillation.

“The rise in popularity of energy drinks, caffeine levels per serving, and the presence of various unregulated ingredients raise concerns about its use in patients with genetic heart disease,” Ackerman and colleagues said.

In an accompanying editorial commentary, researchers at Tel Aviv University stated that, although retrospective and subject to recall bias, the findings reported in this new study “should be seen in the context of the large body of evidence suggesting arrhythmogenic effects of certain foodsespecially when consumed in large quantities or in high concentrations by high-risk patients.”

“While more studies are needed to better identify such foods and understand their arrhythmogenic potential, it appears cautious inform these at-risk populations about the potential harm from consuming energy drinks in large quantities,” wrote Ehud Chorin and Ido Avivi.

Perfect storm

The authors of the research clarified that although a temporal relationship between the consumption of energy drinks and sudden cardiac arrest was found in 5% of the patients studied, other potential “agitators” were also recorded that combined genetic arrhythmia with consumption. of energy drinks and contributed to unleashing what they call a “perfect storm.”

Among those factors, they included the lack of sleep, dehydration, dieting or extreme fastingthe use of drugs that prolong the QT interval and the postpartum period.

“For the general population, the real risk could be low; but for patients with channelopathies and ischemic heart disease, it may be high, and Many times these patients are asymptomatic and without diagnosis. It’s true that we don’t have definitive evidence that the association is causal, but good old common sense can help: If it looks like a duck, swims like a duck, and quacks like a duck, then it’s probably a duck.“, ironically stated in another accompanying editorial comment specialists from the Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics in Milan, Italy.

Ackerman concluded that “although the relative risk is small and the absolute risk of sudden death after consuming an energy drink is even lower, patients with genetic heart disease They must weigh the risks and benefits of consuming such beverages in the future.

“Nothing will happen to most people, just common small tachycardias. But if this occurs in someone who already has a genetic alteration that, for example, favors the production of arrhythmia, it’s a danger“Aguinaga agreed.

For the Argentine doctor, who did not participate in the study, “the decrease in these phenomena is first based on cardiovascular evaluation, to detect these pathologies previously, and the people in whom they are detected energy drinks are going to be banned outright“.

However, he emphasized that they are not recommended for the general population either. “They increase heart rate, blood pressure, cardiac contractility and vulnerability to arrhythmias. The use should be greatly restricted of all these types of products”.

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