The Cardiovascular Effects of Energy Drinks

Editorial | DOI: https://doi.org/10.31579/2641-0419/041 Copyright

The Cardiovascular Effects of Energy Drinks

  • * Associate professor, Department of Physiology, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamilnadu, India.

*Corresponding Author:

Citation:

Copyright: © 2020 Sara Cetin Sanlialp, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: 30 November -0001 | Accepted: 30 November -0001 | Published: 30 November -0001

Keywords: cardiovascular effects; energy drinks

Abstract

Energy drinks are generally consumed by young people to increase athletic performance and concentration. Energy drinks contain high concentrations of caffeine, sugar, vitamin B complex, taurine, ginseng and guarana. There are not enough studies on these stimulants but past case-reports and small studies about energy drinks have been associated with cardiovascular complications. Especially with the use of alcohol or abuse drugs increase their undesirable effects and it may lead to cardiac morbidity and mortality. In this review, we aimed to focus on the effects and complications of energy drinks on the cardiovascular system.

Introduction

Energy drinks are one of the most frequently consumed drinks especially by young people in today. The production of energy drinks started in the 1960s and gradually increased in popularity [1]. Due to its fast growing market, industrial centers interested in the production of beverages are increasing day by day [2]. Energy drinks are often used to increase weight loss, athletic performance and concentration. The most popular brands in the USA are Red Bull, Rockstar, Monster, Full Throttle and Amp [3]. Energy drinks included caffeine, ginseng, taurine, guarana, B vitamine complex and sugar. Although there are more brands in markets, their components are not more different each others [4].

Energy drink generally contains 0.34 mg of caffeine, it has approximately 2-4 times more caffeine components  from tea and soda. Although there is no specific consensus on the upper limit of daily caffeine consumption, it has been reported that caffeine can be safely consumed up to 400 mg per day [5]. The use of Red Bull has been banned in France but   the prohibition has been removed because of the lack of evidence of its toxicity by the European Union [6].  However, the number of visits to the emergency department has been increased due to the adverse events that occurred depending on the substances contained in these beverages [7].  It has been reported that the consumption of energy drinks may be associated with various medical complications such as seizures, anxiety, agitation, hallucinations, migraines, pontine myelinolysis, gastrointestinal upset, rhabdomyolysis, metabolic acidosis, insomnia, arrhythmias, chest pain, and cardiovascular complications [8]. Especially the use of energy drinks together alcohol or drugs may increase the potential effects of energy drinks [9].Moreover, cardiovascular changes caused by energy drinks may cause morbidity and mortality [10]

The components of energy drinks:

Caffeine is the cornerstone of energy drinks and energy drink contains various ingredients that cause stimulant effects. The other components are guarana, taurine, theophylline, ginkgo biloba, ginseng, vitamins, L-carnitine [11].

Caffeine

Caffeine is a methylxanthine derivative that causes activation in the sympathetic nervous system.Although there are many studies on the cardiovascular effects of caffeine, unfortunately the results are contradictory. Caffeine causes positive inotropic effects on miyocardium with inhibiton of phospodiesterase enzyme and in contrast, caffeine causes vasoconstriction by inhibiting adenosine inhibition, platelet aggregation, catecholamine and renin secretion. Caffeine may trigger endothelial dysfunction through sympathetic activation.The effects of caffeine on arrhythmia are variable.The use of overdose may trigger arrhythmia.However, there are many conflicting studies on the effects of caffeine on arrhythmia.Furthermore, the different cardiovascular effects of caffeine on people may be due to the CYP1A2 enzyme gene polymorphism, which is responsible for the primary metabolism of caffeine and the caffeine dose [6].

Taurine: Taurine is an amino acid derivative and is highly present in the heart and skeletal system [12].Taurine causes negative chronotropic effects by reducing myocaridal calcium sensitivity. It provides vasodilation by suppressing the angiotensin 2 system. The caffeine consumption improves lipid profile by increasing LDL receptor upregulation and LDL uptake into the liver [13,14].

Ginseng

Ginseng is one of the populer plants grown in eastern Asia.This plant has stress-reducing, diabetes-healing, erectile dysfunction relief and memory-improving benefits [15]. It has been shown that it increases energy level and contributes to physical performance [16].But excessive consumption can cause drowsiness, headache, agitation, dizziness, hypertension [17].

L-Carnitine

L-carnitine is a naturally occurring amino acid produced predominantly by the liver and kidneys.It plays a role in beta oxidation of fatty acids so it can lead to changes in energy metabolism.It is also involved in the suppression of programmed deaths of immune cells, in the prevention of cellular damage and in the stimulation of hematopesis [18]. Studies have shown that the cardiovascular effects of ginseng are contradictory.In one of the studies, it was shown that ginseng contributed to atherosclerosis but in another study it was claimed that left ventricular remodeling decreased [19, 20].

                             

Figure 1: The chemical structure of energy drink

The Cardiovascular Effects of Energy Drinks:

1) Elevated blood pressure: Many studies have shown that energy drinks may increase blood pressure. In a study, 3 different energy drinks and placebo were presented volunteers one our before the test and their blood pressure were measured 15 minutes after the test. The blood pressures of the participants drinking 3 different energy consumed (163.87 mmhg, 166.47 mmhg, and 165.00 mmhg ) were higher than placebo (156 mmhg ) [21].In another study, Stein et al. reported that  blood pressure and heart rate may elevate a few hours after consumption of the energy drinks [22]. In another study, the redbull energy drink has been elevated blood pressure by increasing cardiac output on echocardiography [23].Consumption of energy drinks in healthy individuals may trigger small fluctuations in blood pressure but blood pressure returns to normal after discontinuation of consumption. But this status may be deferred or difficult in hypertensive patients, so hypertensive individuals should avoid consumption of energy drinks [24].

2) Increased heart rate: The comsumption of energy drinks may increase heart rate., In a study with volunteers, blood pressure, heart rate and electrocardiograms of the participants were measured 48 hours after consumption of energy drink. Although there was no significant change in the electrocardiograms of the participants, their blood pressures increased by 10 mmhg and heart rate by 7 beats [22].  

 

                         

Elevated blood pressure and heart rate

Supraventricular and ventricular tachyarrhythmias

Aortic dissection

Myocardial ischemia, infarction and coronary artery vasospasm

Coronary artery thrombosis and spontan coronary artery dissection

Sudden cardiac death

Table 1: The effects of energy drinks on cardiovascular system        

Conclusion

The previously reported records and small studies suggest that energy drinks may be associated with arrhythmia, QT prolongation, myocardial ischemia and infarction, aortic dissection etc. In particular, the cardiovascular effect of these beverages may be more pronounced in young people with underlying structural heart disease, cardiomyopathy, and canalopathy. By prohibiting or restricting the legal production and sale of these beverages, cardiovascular complications of energy drinks can be prevented. However, further investigations and randomized controlled trials are needed to initiate this legal process and to determine the precise effects of these beverages on cardiovascular health.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

                   

References

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