Energy drink consumption linked to sudden heart attacks in patients with genetic cardiac disease

In a recently published study, Heart rhythmResearchers assessed the temporal association between energy drink consumption and risk of heart attack in patients with genetic heart disease (GHD).

study: Sudden cardiac arrest occurs close in time to the consumption of an energy drinkImage credit: Petro Artem/Shutterstock.com

background

The energy drink market is growing steadily in the United States, with most drinks claiming to contain natural ingredients that classify them as dietary supplements.

As such, there is no Food and Drug Administration (FDA) oversight of these products or their manufacturers. Energy drinks contain stimulants such as caffeine, guarana, and taurine that are not regulated by the FDA, raising concerns about the cumulative effects of caffeine and other unregulated ingredients.

Research suggests a potential correlation between high caffeine intake and sudden cardiac arrest (SCA), and GHD patients are already at increased risk of SCA.

The growing popularity of energy drinks, their increased caffeine content, and the presence of unregulated ingredients have raised concerns about their use in patients with GHD.

Research and Results

In this study, we investigated whether a potential temporal relationship exists between energy drink consumption and cardiac events in patients with GHD.

The research team looked at more than 5,000 patients evaluated at Mayo Clinic between 2000 and 2023 to identify SCA survivors. Among SCA survivors, the team identified patients who had a sentinel or breakthrough heart attack (BCE) in close temporal proximity to energy drink consumption.

Sentinel events occurred before diagnosis, whereas BCEs occurred after the event was diagnosed and treatment initiation.Medical records were accessed to obtain data on demographics, clinical characteristics, energy drink consumption, and temporal relationship to SCA.In total, 144 SCA survivors were identified, of which 73 were women.

Seven patients (six of them female) had a temporal relationship between SCA and energy drink consumption. SCA became a warning event in six patients and BCE in one patient. Furthermore, 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.

The frequency of energy drink consumption was high in 3 patients and low in 4. The time between energy drink consumption and the event varied from immediately before the event to within 12 hours.

A variety of energy drinks were consumed, with caffeine contents ranging from 80 mg to over 200 mg per serving. One patient required manual resuscitation and six required emergency shock.

Six patients were discharged with an implantable cardioverter defibrillator (ICD), two were discharged with medical therapy, and two underwent left cardiac sympathetic blockade (LCSD).All subjects discontinued energy drink consumption after SCA and have remained free of BCE over a mean follow-up period of 52 months.

The first patient was a 32-year-old woman who was 11 weeks postpartum before the accident. She consumed an energy drink after exercise and suddenly suffered cardiac arrest a few hours later, requiring defibrillation.

The patient was diagnosed with IVF and discharged with a subcutaneous ICD. The second case involved a 37-year-old woman who developed severe symptoms several hours after consuming an energy drink and was given an electric shock by paramedics.

The patient was diagnosed with IVF and discharged with an ICD and nadolol.The third case was a 20-year-old man who regularly consumed energy drinks before exercise.

The patient collapsed while sprinting during practice and received two shocks from an automated external defibrillator (AED). The patient was diagnosed with IVF and received an ICD.

The fourth case involved a 28-year-old woman who experienced a sentinel event after ingesting a large amount of energy drink, suddenly collapsing, and requiring AED shock.

The patient was discharged on beta-blocker therapy and a pacemaker-defibrillator. Genetic testing detected a ryanodine receptor 2 (RYR2) mutation, and CPVT was diagnosed.

The fifth case is a 21-year-old female who presented with syncope at age 7 and was found to have RYR2-mediated CPVT through genetic testing. The patient had an ICD implanted with good adherence to treatment for 10 years and developed SCA.

Three years later, another SCA occurred after consuming an energy drink: the patient collapsed at work, required three shocks with an AED, and has not experienced a BCE since.

Conclusion

This study describes seven cases of GHD patients who experienced SCA in close temporal proximity to energy drink consumption. Most cases were not frequent energy drink consumers, and only one patient had previously experienced and been treated for GHD.

Although a temporal relationship was found between SCA events and energy drink consumption, some events occurred among potential instigators that may have contributed.

Of note, this study was conducted at a single center with a small cohort, so conclusions about the direct impact of energy drinks on patients with GHD should be made with caution.

Overall, the researchers observed that 5% of SCA survivors consumed at least one energy drink before onset. Thus, patients should limit their energy drink intake, and the FDA should provide guidelines for the safe and appropriate use of energy drinks.