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Review of Published Cases of Adverse Cardiovascular Events After Ingestion of Energy Drinks

https://doi.org/10.1016/j.amjcard.2013.08.058Get rights and content

Energy drink (ED) consumption has been linked to several adverse event reports, but there is limited data on related cardiovascular (CV) complications. We describe clinical characteristics, ED consumption profile, co-ingestions, and results of cardiovascular testing in a series of cardiovascular event reports temporally related to ED consumption from the literature. We searched PubMed and Embase for case reports in peer-reviewed journals from January 1, 1980, to February 1, 2013, in which an acute CV event was associated temporally with ED consumption. We identified 14 eligible articles involving 15 cases (5 atrial arrhythmias, 5 ventricular arrhythmias, 1 QT prolongation, 4 ST-segment elevations). Two additional cases of cardiac arrest from our institution are included. Of these 17 cases of ED-related acute CV events (13 male cases; 15 cases aged <30 years, age range 13 to 58 years), only 1 had minor previous cardiac disease. Cardiac investigations did not reveal any predisposing cardiac abnormality in the majority of cases. Of the 11 cases related to a serious event (i.e., cardiac arrest, ventricular arrhythmia, or ST-segment elevations), 5 reported acute heavy ED consumption, 4 reported co-ingestions with alcohol or other drugs, and 2 were found to have a channelopathy. Potential mechanisms of ED-related cardiac events are reviewed. In conclusion, several adverse CV events after consuming ED have been reported in the literature. Although causality cannot be inferred from our series, physicians should routinely inquire about ED consumption in relevant cases, and vulnerable consumers such as youth should be advised that caution is warranted with heavy consumption and/or with concomitant alcohol or drug ingestion.

Section snippets

Methods

We performed a systematic review of the Medline and Embase databases for peer-reviewed articles published between January 1, 1980, and February 1, 2013, containing the search terms “energy drinks,” “adverse effects,” “myocardial infarction,” “cardiac arrest,” and “arrhythmia” in various combinations. The cases were independently extracted by 2 reviewers without any discrepancies. Articles were excluded if they were not related to EDs and CV disease, were physiologic or epidemiologic studies, or

Results

Our search identified 657 articles. In total, 7 articles containing 8 cases met our inclusion criteria on the initial search (see Figure 1). Seven additional articles were identified on the manual search. We also included 2 additional cases from our institution (McGill University, Montreal, Canada). A detailed description of each case is available in the online supplementary materials. Table 1 contains a list of all 17 cases (15 cases from the literature and 2 cases from our institution).

Discussion

Our case series of 17 cases represents the first systematic review of the literature of ED-associated acute adverse CV events and adds to the growing number of adverse events related to EDs reported by the FDA and by health authorities in Canada. Despite the many adverse events reported to regulatory agencies, few data have been released regarding the clinical characteristics of these cases to help inform the CV community about these events. Our results, although prone to publication bias, show

Disclosures

The authors have no conflicts of interest to disclose.

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