Energy Drinks: Cardiovascular Complications

Higgins JP; Jogimahanti AV

Review Article

Austin J Clin Cardiolog. 2021; 7(3): 1085.

Energy Drinks: Cardiovascular Complications

Higgins JP* and Jogimahanti AV

McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth) Houston, TX, USA

*Corresponding author: John P Higgins, Professor of Medicine, The Division of Cardiovascular Diseases, Cardiology Department, Lyndon B. Johnson General Hospital, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), 6431 Fannin St., MSB 1.248, Houston, TX 77030, USA

Received: October 29, 2021; Accepted: November 25, 2021; Published: December 02, 2021

Abstract

Energy Drinks (EDs) are gaining popularity every year with a broad consumer base including athletes, amateur competitors, and office workers trying to avoid afternoon fatigue. Evidence suggests an association between ED consumption and adverse effects, especially in at-risk populations including those of young age, the caffeine-nai¨ve/sensitive, women, competitive athletes, and those with underlying cardiovascular disease. This paper summarizes the cardiovascular complications associated with ED use and provides suggestions on the consumption of these drinks in various populations.

Keywords: Energy drinks; Endothelial function; Heart; Cardiovascular complications; Caffeine; Myocardial infarction; Arrhythmia; QTc interval

Introduction

Energy Drinks (EDs) are caffeinated beverages that are marketed to improve energy, athletic performance, concentration, endurance, and weight loss [1-4]. The consumption of EDs has increased significantly in recent years, with a growing market that is estimated to reach $61 billion by 2021 worldwide.

It is important to recognize the difference between EDs and traditional soft drinks such as sodas, as well as coffee, tea, sports drinks (such as Gatorade), juices, or flavored water [5]. Some believe that “Energy drinks are the Wild West of the soft drinks industry: often shockingly and unnecessarily high in sugar and caffeine...” [6].

EDs typically contain taurine (an amino acid), niacin, pyridoxine, cyanocobalamin (B12), riboflavin (B2), ginseng extract, glucuronolactone (a glucose metabolite), inositol (B8), guarana (contains caffeine, theobromine, and theophylline), ephedra, yohimbine, Ginkgo biloba, kola nut, theophylline, sugars, vitamins, herbs, and L-carnitine [7]. Caffeine has even been added to foods too, and examples of foods and beverages caffeine content are freely available [8,9].

A typical ED contains 0.34mg of caffeine per mL, which exceeds the FDA imposes a limit of 71mg of caffeine per 12 fl oz of soda (200 parts per million) or 0.2mg of caffeine per mL [2,8,9]. Some EDs do not disclose total caffeine, as they may fail to account for the caffeine, contributed by “energy blend” ingredients (guarana, kola nut, yerba mate) [10,11].

While most healthy adults can safely consume up to 400mg per day, other groups should be cautious [8,12]. Pregnant women should limit ED use to 200mg per day, while adolescent adolescents and children should completely avoid consumption due to unknown risk profiles [13-16]. Despite the risk, consumption of EDs is highest among adolescents/young students and declines with increasing age [13]. EDs are now consumed by 30%-50% of adolescents, with 31% of 12-19-year-olds reporting regular use [2,15]. Up to 78% of young adults and students are consuming EDs on a weekly basis [17,18].

In a recent metaanalysis, adverse effects of EDs were common. Frequently reported adverse events in the pediatric population were insomnia (35%), stress (35%), and depressive mood (23%). Frequently reported adverse events in the adult population were insomnia (25%), jitteriness/restlessness/shaking hands (30%), and gastrointestinal upset (22%).

ED consumption has been significantly associated with lower breakfast frequency, higher sugar-sweetened soda intake, video game use, unhealthy dietary and weight-control behaviors, insomnia, and later substance use [17,19,20]. ED consumption is associated with adolescent use of alcohol, tobacco, cannabis, prescription stimulants, and analgesics.

Alcoholic beverages prepared with EDs are popular amongst adolescents and college students and associated with smoking and illicit drug use [21,22-24]. Harmful consequences include automobile fatalities and increased rates of sexual abuse. [25,26]. Moreover, alcohol consumption can increase the half-life of caffeine by up to 72%, which may potentiate the ED exposure effects [27]. Combining energy drinks with alcohol also precipitates adverse cardiovascular events, posing a risk to the health of children and adolescents.

Emergency department visits related to complications of ED consumption are increasing in frequency, whether for toxicity or simply exposure-related, including young children [28-30]. Consumption of EDs has been associated with exacerbation of underlying medical conditions too [2,30-34].

Cardiovascular complications associated with EDs include increased cardiometabolic risk with high intake of sugar, short-term blood pressure increases and a decrease in cerebral blood flow due to the caffeine content, increased or decreased blood pressure from taurine, unmasked cardiac conditions, such as channelopathies, and atrial and ventral arrhythmias. Cardiovascular complications can also arise when EDs are mixed with stimulants, amiodarone, potent CYP1A2 inhibitors, warfarin, digoxin, or corticosteroids. Adverse events associated with energy drinks may have a genetic predisposition.

This review will focus on ED complications involving the cardiovascular system.

Cardiovascular Complications

Cardiovascular complications of consuming EDs may be related to acute or chronic exposure. These are listed in Table 1 and are detailed below.

Table 1: Cardiovascular complications associated with energy drinks (EDs).




  
    Acute Effects
  
  
    Increased Blood Pressure (Table 2)
  
  
    Increased Heart Rate (Table 3)
  
  
    Increased Corrected QT (QTc) Interval (Table 4)
  
  
    Supraventricular Arrythmia (Table 5)
  
  
    Ventricular Arrythmia (Table 6)
  
  
    Coronary Artery Spasm (Table 7)
  
  
    Coronary Artery Thrombosis (Table 8)
  
  
    Spontaneous Coronary    Artery Dissection (Table 9) 
  
  
    Acute Coronary Syndrome (Table 10)
  
  
    Stress-Induced (Takotsubo) Cardiomyopathy
  
  
    Aortic Dissection (Table 11)
  
  
    Postural Orthostatic    Tachycardia Syndrome (POTS) 
  
  
    Sudden Cardiac Death (Table 12)
  
  
    Endothelial Dysfunction (Table 13)
  
  
    Possible Chronic Effects
  
  
    Hypertension
  
  
    Obesity
  
  
    Coronary Artery Disease
  
  
    Atherosclerosis
  
  
    Cerebrovascular Disease
  
  
    Peripheral Arterial Disease



Table 1: Cardiovascular complications associated with energy drinks (EDs).

Acute Effects

Increased blood pressure

Numerous studies have associated EDs and their ingredients with acute hypertension (Table 2) [35,36]. Acute caffeine consumption can increase blood pressure and heart rate by increasing plasma renin, catecholamines, and dopamine [11,37]. In addition, synergistic effects between components of the “energy blend” used in EDs may also contribute, especially in children and hypertensive patients [1,35]. The effects of caffeine on hemodynamics can last up to 5h after ED ingestion. Such effects may be amplified by performing physical activity just after consumption [38-40].

Table 2: Increased blood pressure associated with energy drinks.




  
    Authors (Ref)
    Population
    Energy Drink (ED)
    Results
  
  
    Grasser et al. [35]
    12 women
    355mL of Red Bull
    SBP*: Increased by 5.2

      DBP*: Increased by 6.1
  
  
    Steinke et al. [41]
    15 healthy 18-40 year olds
    Two cans of 500mL EDs
    SBP: Increased by 7.2% and 9.6%

      DBP: Increased by 7.0% and 7.8%
  
  
    Franks et al. [42]
    9 Subjects (5 females, mean age: 27.7)
    Red Bull
    SBP: Increased by 5.8mmHg

      DBP: Increased by 5.4mmHg
  
  
    Elitok et al. [36]
    50 young, healthy subjects
    Red Bull
    SBP: Increased by 9mmHg

      DBP: Increased by 3mmHg
  
  
    Peveler et al. [43]
    15 recreationally active men and women
    
      Red    Bull
      Monster
      5 hour    Energy
    
    SBP:

      Increased by 6.94mmHg

      Increased by 9.54mmHg

      Increased by 8.07mmHg

      DBP:

      Increased by 0.67mmHg

      Increased by 1.33mmHg

      Increased by 1.33mmHg
  
  
    Kozik et al. [44]
    14 healthy young subjects (mean age 28.6)

      38 adults (19 women, mean BMI 32kg/m2,    mean age 22y)
    32 ounces of Monster energy drink
    SBP: Increased by 18mmHg
  
  
    Basari et al. [45]
    38 adults (19 women, mean BMI 32 kg/m2,    mean age 22y)
    3-4 cans of 250mL Red Bull
    SBP: Increased by 3.8mmHg
  
  
    Nowak et al. [46]
    Young adults (average age 25?years;    49 female and 39 male participants)
    600mL of an unspecified ED
    SBP: Increased by 5.6mmHg

      DBP: Increased by 10.9mmHg
  
  
    Brothers et al. [47]
    15 participants
    
      16 oz    Monster Ed
      24 oz    of Monster ED
      Coffee
    
    SBP:

      Decreased by 2mmHg

      Decreased by 2mmHg

      No change in mmHg

      DBP:

      No change in mmHg

      No change in mmHg

      Increase in 1mmHg
  
  
    Gray et al. [48]
    24 LQTS patients aged 16-50 years
    2 Red bull sugar-free cans
    SBP: Increased by 6mmHg

      DBP: Increased by 6mmHg
  
  
    Shah et al. [49]
    Healthy volunteers between 18 and 40 years    of age with no premorbid conditions were included
    1 bottle (2 fl. Oz) of 5-hour Energy
    SBP: Increased by 5mmHg

      DBP: Increased by 4 mmHg



Table 2: Increased blood pressure associated with energy drinks.

Recap: A typical increase in systolic and diastolic blood pressure in normal healthy persons 1-2 h following consumption of ED is approximately 4-9 mmHg and 1-6 mmHg respectively.

Increased heart rate

Acute consumption of EDs has been associated with small but significant increases in heart rate (Table 3).

Table 3: Increased heart rate associated with energy drinks.




  
    Authors (Ref)
    Population
    Energy Drink (ED)
    Results
  
  
    Grasser et al. [35]
    25 young non-obese and healthy subjects
    Red Bull
    Increase in HR* relative to water control
  
  
    Steinke et al. [41]
    15 healthy 18-40-year-olds
    2-4 hours after ED consumption
    Increase in HR by 7.8% and 11.0%
  
  
    Elitok et al. [36]
    50 young, healthy subjects (mean age 25-year-old)
    Red Bull
    Increase in HR by 8 bpm
  
  
    Nowak et al. [46]
    Young adults (average age 25?years;    49 female and 39 male participants) in Bydgoszcz, Poland
    600mL of an unspecified ED
    Increase in HR by 3.8 bpm
  
  
    Brothers et al. [47]
    15 healthy participants
    
      16 oz    Monster Ed
      24 oz    of Monster ED
      Coffee
    
    
      Increase    in HR by 2bpm
      Increase    in HR by 4bpm
      No    change in HR
    
  
  
    *HR: Heart Rate.



Table 3: Increased heart rate associated with energy drinks.

Recap: A typical increase in heart rate in normal healthy persons 1-2 h following consumption of ED is approximately 2-8 beats per minute.

Increased corrected QT (QTc) interval

Possibly, due to the effect of ingredients such as taurine on multiple cardiac ion channels [49,50], EDs have been associated with prolongation of the QT interval, although not all studies showed a significant increase (Table 4) [51,54].

Table 4: Increased Corrected QT (QTc) Interval associated with energy drinks.




  
    Authors (Ref)
    Population
    Energy Drink (ED)
    Results
  
  
    Steinke et al. [41]
    15 healthy 18-40 year olds
    2-4 hours after ED consumption
    Increase in QTc by 2.4% and 5.0%
  
  
    Rottlaender D. [52]
    22 year old female with out of hospital    cardiac arrest
    Consumed six cans of caffeinated ED within 4    hours
    Increased to 526ms* from baseline 419
  
  
    Dufendach et al. [53]
    13-year-old-girl with Type I Long QT Syndrome    (LQTS)
    Consumed one 16 oz. can of an ED
    Increased to 561ms
  
  
    Brothers et al. [47]
    15 healthy participants
    
      16 oz    Monster
      24 oz    Monster
      Coffee
    
    
      Increased    by 6ms
      Increased    by 8ms
      Increased    by 4ms
    
  
  
    Basari et al. [45]
    38 adults (19 women, mean BMI 32 kg/m2,    mean age 22y)
    3-4 cans of 250mL Red Bull
    Increased by 7.5ms
  
  
    Gray et al. [48]
    24 LQTS patients aged 16-50 years
    Unspecified ED
    Increased by 4ms
  
  
    Shah et al. [49]
    Healthy volunteers between 18 and 40 years    of age with no premorbid conditions were included
    1 bottle (2 fl. Oz) of 5-hour Energy
    Decreased by 2ms
  
  
    *ms: milliseconds.



Table 4: Increased Corrected QT (QTc) Interval associated with energy drinks.

Recap: A typical increase in heart rate in normal healthy persons 1-2 h following consumption of ED is approximately 4-8 milliseconds.

Supraventricular arrhythmia

Consumption of EDs and other energy products has been associated with precipitation and/or exacerbation of supraventricular arrhythmia (Table 5) [15,55]. Atrial fibrillation, which is rare in the pediatric population, has been observed following acute ingestion of EDs in young adults [56,57].

Table 5: Supraventricular Arrythmia associated with energy drinks.




  
    Authors (Ref)
    Population
    Energy Drink (ED)
    Results
  
  
    Izquierdo et al. [58]
    13-year-old healthy boy in Spain
    Unspecified “Eds”
    Atrial fibrillation with rapid ventricular    response
  
  
    Nagajothi et al. [59]
    23-year-old woman with no medical history
    GNC Speed Shot (GNC Corporation, Pittsburgh, PA,    USA) and a Mountain Dew (PepsiCo, Inc., Purchase, NY, USA) soda drink
    Narrow Complex Tachycardia with Ventricular Rate    of 219
  
  
    Kaoukis et al. [60]
    24-year-old man
    Unspecified ED
    Supraventricular and Ventricular Tachycardia,    Later Diagnosed as Takotsubo Cardiomyopathy
  
  
    Peake et al. [61]
    58-year-old previously healthy male
    One bottle (1000 mL) per week of a highly    caffeinated (caffeine content 4.04 mg/mL) commercially available ED for six    months
    Atrial fibrillation with rapid ventricular    response
  
  
    Di Rocco et al. [57]
    Two Caucasian Adolescent Boys, aged 14 and 16, with    no significant past medical history
    One Can of Red Bull
    Atrial Fibrillation
  
  
    Mattioli et al. [62]
    22-year-old man, with a negative family,    personal, and pharmacological history
    750mL of ED
    Atrial fibrillation with rapid ventricular    response
  
  
    Mattioli et al. [62]
    23-year-old-man, without previous cardiac disease    or pharmacological treatment
    600mL of ED
    Atrial fibrillation with rapid ventricular    response
  
  
    Mattioli et al. [62]
    26-year-old-man, without any pharmacological,    familiar and personal history
    600mL of ED
    Atrial fibrillation with rapid ventricular    response



Table 5: Supraventricular Arrythmia associated with energy drinks.

Recap: Supraventricular arrhythmias, especially atrial fibrillation, can be seen in normal healthy persons following consumption of EDs.

Ventricular arrhythmia

Sudden cardiac death due to ventricular arrythmias has been associated with ED use through means such as increasing catecholamines, electrolyte abnormalities inducing hypokalemia, or inactivation of sodium channels (Table 6) [10]. In addition, high doses of caffeine, like those found in EDs, may exacerbate cardiac conditions such as ion channelopathies and hypertrophic cardiomyopathy [2]. Taurine and guarana also have proarrhythmic properties, making their consumption by patients with underlying structural heart disease potentially dangerous [63].

Table 6: Ventricular Arrythmia associated with energy drinks.




  
    Authors (Ref)
    Population
    Energy Drink (ED)
    Results
  
  
    Avci et al. [64]
    28-year-old-man
    Three cans of an ED
    Ventricular Tachycardia
  
  
    Cannon et al. [65]
    25-year-old woman with pre-existing mitral valve    prolapse
    55mL of Race 2005 Energy Blast with Guarana and    Ginseng
    Ventricular Tachycardia
  
  
    Berger et al. [66]
    28-year-old healthy man
    7-8 cans of unspecified EDs
    Intractable Ventricular Fibrillation
  
  
    Rutledge et al. [67]
    24-year-old male with no previous medical history
    Redbull ED
    Ventricular Fibrillation
  
  
    Goldfarb et al. [68]
    19-year-old man
    Monster ED
    Ventricular Fibrillation
  
  
    Goldfarb et al. [68]
    57-year-old male
    Multiple NOS ED
    Cardiac Arrest
  
  
    Kaoukis et al. [60]
    24-year-old
    Unspecified ED
    Supraventricular and Ventricular Tachycardia
  
  
    Ward et al. [63]
    45-year-old man with a history of tetralogy of    Fallot repair at age 5 and AICD placement at age 40
    3 Red Bull EDs
    Ventricular Tachycardia and Ventricular    Fibrillation
  
  
    Hanan Israelit et al. [69]
    24-year-old Caucasian man with a history of mild    hypertension
    20 cans of ED “XL”
    Ventricular Fibrillation ?    Myocardial Infarction



Table 6: Ventricular Arrythmia associated with energy drinks.

Recap: Ventricular arrhythmias (ventricular tachycardia and ventricular fibrillation) can be seen in normal healthy persons or in those with underlying cardiovascular conditions such as Brugada Syndrome, usually following consumption of multiple EDs over a short period of time.

Coronary artery spasm

Consuming multiple cans of energy drinks with resultant high levels of caffeine (400-800 mg) as well as taurine (2000-8000 mg) have been associated with coronary artery vasospasm (Table 7). The mechanism is likely secondary to inhibition of adenosine A2 channels by caffeine [70,71]. However, taurine modulates calcium signaling and high levels can affect calcium concentration both intra- and extracellularly [11]. In addition, there is some evidence that taurine may enhance the physiologic actions of caffeine, leading to increased inotropy, and thus may contribute to coronary artery spasm [70,72].

Table 7: Coronary Artery Spasm associated with energy drinks.




  
    Authors (Ref)
    Population
    Energy Drink (ED)
    Results
  
  
    Scott et al. [70]
    19-year-old-man
    2-3 Red Bull ED weekly
    Coronary Artery Vasospasm
  
  
    Berger et al. [66]
    28-year-old healthy man
    7-8 cans of an unspecified ED
    Coronary Artery Vasospasm
  
  
    Wilson et al. [73]
    17-year-old male
    3-4 Red Bull with 2-3 Monster
    Coronary Artery Vasospasm



Table 7: Coronary Artery Spasm associated with energy drinks.

Recap: Coronary artery spasm may occur in normal healthy persons following consumption of multiple (2–8 cans) of EDs containing high levels of caffeine and taurine.

Coronary artery thrombosis

Coronary artery thrombosis has been associated with consumption of multiple (≥3 cans) EDs and sometimes in combination with alcohol (Table 8) [74,75].

Table 8: Coronary Artery Thrombosis associated with energy drinks.




  
    Authors (Ref)
    Population
    Energy Drink (ED)
    Symptoms
    Results
  
  
    Benjo et al. [74]
    24-year-old African-American male
    Three drinks of vodka mixed with an ED
    Nausea, Emesis, Palpitations, Severe Retrosternal    Chest Pain
    Myocardial Infarction with Topnonin I of 38ng/mL
  
  
    Unal et al. [75]
    32-year-old previously healthy man
    Five bottles of energy drink
    Retrosternal chest pain, palpations, and emesis
    Angiography demonstrated large thrombus occupying    nearly 90% of L Main Coronary Artery



Table 8: Coronary Artery Thrombosis associated with energy drinks.

Recap: Coronary artery thrombosis may occur in normal healthy persons following consumption of multiple (3 or more cans) of EDs.

Spontaneous coronary artery dissection

Spontaneous coronary artery dissection has been described in association with ED consumption in a 13-year-old and 25-year-old male, with likely excess consumption [76,77] (Table 9).

Table 9: Spontaneous Coronary Artery Dissection associated with energy drinks.




  
    Authors (Ref)
    Population
    Energy Drink (ED)
    Symptoms
    Results
  
  
    Solomin et al. [76]
    13-year-old male
    Ingested an unknown ED
    Acute-onset, “crushing”, mid-sterna chest pain
    ECG revealed sinus rhythm 2- to 3-mm ST-segment    elevations in leads II, III, aVF, and V3 through V5
  
  
    Zacher et al. [77]
    25-year-old male
    Consumed “more than 8 cans” of EDs
    Chest Pain, persistent vomiting
    ECG showed a sinus rhythm with ST-segment    elevation in I, aVL, and V II, III, aVF, and V3 through V1-V4 and    corresponding inferior ST-segment-depression



Table 9: Spontaneous Coronary Artery Dissection associated with energy drinks.

Recap: Spontaneous coronary artery dissection may occur in normal healthy persons following consumption of multiple (3 or more cans) of EDs.

Acute coronary syndrome

Acute coronary syndrome in association with energy drink consumption has been described in young males, age 17-32 years old, with multiple cans of EDs typically being consumed [66,69,73,75,76,78]. Some required stenting, others were found to have thrombosis or spasm. The etiology may include high cardiovascular demand from excess caffeine, coronary vasospasm, endothelial dysfunction, and a temporary hypercoagulable state.

A notable example is was a 26-year-old Hispanic male with a 2-year history of smoking presented with an acute ST-Elevation Myocardial Infarction (Table 10) [76]. The patient reported consuming between eight and ten 473 mL cans of ED per day (Monster, Rockstar, and others). Cardiac catheterization subsequently confirmed total occlusion of his left circumflex coronary artery; the patient received a drug-eluting stent with resolution of his electrocardiogram changes.

Authors (Ref)	Population	Energy Drink (ED)	Results
Solomin et al. [76]	26-year-old male	Consumed between eight and ten 473 mL cans of ED per day (Monster, Rockstar, and others)	Cardiac catheterization subsequently confirmed total occlusion of his left circumflex coronary artery
Wajih Ullah et al. [78]	25-year-old male	Consumed “massive” quantities of energy drinks	Patient had an acute myocardial infarction, confirmed by ECG showing ST depression in precordial leads V2-V6
Berger et al. [66]	19-year-old male	Consumed 2-3 cans of a “popular” ED in days leading up to event	ECG and Troponin value of 34.7μg/ml confirmed diagnosis of a STEMI*
Hanan Israelit et al. [69]	24-year-old male	Consumed 20 cans of an ED with 3,4-methylenedioxymethamphetamine (MDMA)	ECG revealed widespread ST elevations, confirming diagnosis of STEMI
Wilson et al. [73]	17-year-old male	Consumed 5-7 cans of caffeinated ED	Cardiac biomarkers and ECG confirmed presence of STEMI
Unal et al. [75]	32-year-old male	Consumed five bottles of ED	ECG showing ST elevations and coronary angiography showing thrombus occupying 90% of left main coronary artery
*STEMI ST: Segment Elevation Myocardial Infarction.

Authors (Ref)	Population	Energy Drink (ED)	Results
Jonjev et al. [81]	54-year-old Caucasian man with uncontrolled hypertension and obesity	4-5 Unspecified EDs	Acute Aortic Dissection (De Bakey Type I)
Jonjev et al. [81]	26-year-old Caucasian man with history of bicuspid aortic valve	5-6 Unspecified EDs	Aortic Dissection (De Bakey Type II)
Jonjev et al. [81]	48-year-old Caucasian man with history of hypertension and myocardial infarction	“Several” High Energy Drinks	Aortic Dissection (De Bakey Type I)

Authors (Ref)	Population	Energy Drink (ED)	Results
CFSAN Adverse Event Reporting System [92]	14-year-old girl	48 oz of Monster ED	Cardiac Arrythmia
CFSAN Adverse Event Reporting System [93]	18-year-old man	2 cans of Red Bull ED	Sudden Death During Basketball
CFSAN Adverse Event Reporting System [94]	16-year-old girl	“Several” Red Bull Eds	Cardiac Arrest

Authors (Ref)	Population	Energy Drink (ED)	Results
Worthley et al. [90]	50 healthy young adults	250mL of a sugar-free ED	An acute increase in platelet aggregation and decreased endothelial function.
Higgins et al. [89]	11 healthy medical students (9 males, average age 24.5 years, average BMI 22.8kg/m2).	24-oz can of Monster ED	Attenuated peak flow-mediated dilatation response (mean±SD): BL group 5.9%±4.6% vs. ED group 1.9%±2.1%; p=0.03. Thus, acute exposure to an ED was shown to impair arterial endothelial function in healthy young adults.
Higgins et al. [105]	47-year-old healthy Caucasian male.	24-oz Monster energy	Progressive attenuation of peak flow-mediated dilatation response ninety minutes later, with a peak reduction of about 4% at 90min.
Higgins et al. [119]	44 healthy medical students (34 males, average age 24.7 years, average BMI 23.4kg/m2).	24-oz can of Monster ED	Attenuated peak flow-mediated dilatation response (mean±SD): BL group 5.1%±4.1% vs. ED group 2.8%±3.8%; p=0.004. Thus, acute exposure to an ED was shown to impair arterial endothelial function in healthy young adults.

Energy Drinks: Cardiovascular Complications

Abstract

Introduction

Cardiovascular Complications

Acute Effects

Increased blood pressure

Increased heart rate

Increased corrected QT (QTc) interval

Supraventricular arrhythmia

Ventricular arrhythmia

Coronary artery spasm

Coronary artery thrombosis

Spontaneous coronary artery dissection

Acute coronary syndrome

Stress-induced (Takotsubo) cardiomyopathy

Aortic dissection

Postural orthostatic tachycardia syndrome (POTS)

Sudden cardiac death

Endothelial dysfunction

Possible Chronic Effects

Recommendations

Conclusions

Author Contributions

References