Energy drinks may increase risk of electrical disturbances in the heart

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Drinking 32 ounces of an energy drink in a short time-span may increase blood pressure and the risk of electrical disturbances in the heart, which affect heart rhythm, according to a small study. The study enrolled 34 healthy volunteers between the ages of 18 and 40 years. Participants were randomly assigned to drink 32 ounces of one of two commercially available caffeinated energy drinks or a placebo drink on three separate days. The drinks were consumed within a 60-minute period but no faster than one 16-ounce bottle in 30 minutes.

Researchers measured the electrical activity of the volunteers’ hearts by electrocardiogram. They also recorded participant’s blood pressure. All measurements were taken at the study’s start and every 30 minutes for 4 hours after drink consumption.

Both energy beverages tested contained 304mg to 320mg of caffeine per 32 fluid ounces. Caffeine at doses under 400mg is not expected to induce any electro-cardiographic changes. Other common ingredients in the energy drinks in the study included taurine (an amino acid), glucuronolactone (found in plants and connective tissues) and B-vitamins. The placebo drink contained carbonated water, lime juice and cherry flavouring.

In participants who consumed either type of energy drink, researchers found that the QT interval was 6 milliseconds or 7.7 milliseconds higher at 4 hours compared to placebo drinkers. The QT interval is a measurement of the time it takes ventricles in the heart (the lower chambers) to prepare to generate a beat again. If this time interval is either too short or too long, it can cause the heart to beat abnormally. The resulting arrhythmia can be life-threatening.

The results of the study confirm previous findings and suggest that the QT interval changes are generally sustained over the four-hour monitoring period rather than being a short-lasting effect after consuming 32-ounces of an energy drink.

Researchers also found a statistically significant 4 to 5 mm Hg increase in systolic and diastolic blood pressure in participants who consumed the energy drinks.

“We found an association between consuming energy drinks and changes in QT intervals and blood pressure that cannot be attributed to caffeine. We urgently need to investigate the particular ingredient or combination of ingredients in different types of energy drinks that might explain the findings seen in our clinical trial,” said lead author Dr Sachin A Shah, professor of pharmacy practice at University of the Pacific, Thomas J Long School of Pharmacy and Health Sciences in Stockton, California.

The study is the largest controlled study of the effects of energy drinks on the heart and blood pressure in young healthy volunteers. Estimates indicate that about 30% of teenagers between the ages of 12 through 17 years in the US consume energy drinks on a regular basis, which have been linked to increased emergency room visits and death.

“Energy drinks are readily accessible and commonly consumed by a large number of teens and young adults, including college students. Understanding how these drinks affect the heart is extremely important,” said study co-author Dr Kate O’Dell, professor of pharmacy and director of experiential programmes at the Thomas J Long School of Pharmacy and Health Sciences.

Among the study’s limitations, it was designed to assess the effects of short-term consumption of an energy drink and does not provide insight into long-term effects nor the effects of routine energy drink consumption. Additionally, energy drink consumption was evaluated alone, and it is not uncommon for energy drinks to be consumed in combination with other substances such as alcohol. Finally, the study included only healthy individuals between the ages of 18 to 40 years and the results may be different in other populations.

“The public should be aware of the impact of energy drinks on their body especially if they have other underlying health conditions,” Shah said. “Healthcare professionals should advise certain patient populations, for example, people with underlying congenital or acquired long QT syndrome or high blood pressure, to limit or monitor their consumption.”

The University of the Pacific supported the study.

Abstract
Background: Energy drinks have been linked to an increase in emergency room visits and deaths. We aim to determine the impact of energy drinks on electrocardiographic and hemodynamic parameters in young healthy volunteers.
Methods and Results: A randomized, double‐masked, placebo‐controlled, crossover study was conducted in healthy volunteers. Participants consumed 32 oz of either energy drink A, energy drink B, or placebo within 60 minutes on 3 study days with a 6‐day washout period in between. The primary end point of QTc interval and secondary end points of QT interval, PR interval, QRS duration, heart rate, and brachial and central blood pressures were measured at baseline, and every 30 minutes for 240 minutes. A repeated‐measures 2‐way analysis of variance was performed with the main effects of intervention, time, and an interaction of intervention and time. Thirty‐four participants were included (age 22.1±3.0 years). The interaction term of intervention and time was statistically significant for Bazett’s corrected QT interval, Fridericia’s corrected QT interval, QT, PR, QRS duration, heart rate, systolic blood pressure, diastolic blood pressure, central systolic blood pressure, and central diastolic blood pressure (all P<0.001). The maximum change from baseline in Bazett’s corrected QT interval for drinks A, B, and placebo were +17.9±13.9, +19.6±15.8, and +11.9±11.1 ms, respectively (P=0.005 for ANOVA) (P=0.04 and <0.01, respectively compared with placebo). Peripheral and central systolic and diastolic blood pressure were statistically significantly different compared with placebo (all P<0.001).
Conclusion: Energy drinks significantly prolong the QTc interval and raise blood pressure.

Authors
Sachin A Shah, Andy H Szeto, Raechel Farewell, Allen Shek, Dorothy Fan, Kathy N Quach, Mouchumi Bhattacharyya, Jasmine Elmiari, Winny Chan, Kate O’Dell, Nancy Nguyen, Tracey J McGaughey, Javed M Nasir, Sanjay Kaul

American Heart Association material
Journal of the American Heart Association abstract


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