With Which Mechanism the Overuse of Energy Drinks May Induce Acute Myocardial Ischemia?

Abstract

Dear Editor, I read with interest the case presented by Wilson et al. [1] recently published in cardiovascular Toxicology. They reported a case of 17-year-old male who had been diagnosed with transient coronary vasospasms as a result of drinking a disproportionate amount of caffeinated energy drinks (3–4 Redbull 80 mg of caffeine/can and 2–3 Monster 160 mg of caffeine/can) prior to presentation. Three points worth mentioning about this case that may be interesting for the readers. First, in addition to taurine and caffeine that the authors have mentioned, Redbull contains glucuronolactone (a glucose metabolite) and Monster contains varying amounts of glucuronolactone, L-Carnitine (an amino acid), guarana extract (from a South American plant; Paullinia cupana), and ginseng extract (from an East Asian herb) [2, 3]. It is important to note that guarana contains caffeine, theobromine, and theophylline in varying quantities. Some studies have suggested that the caffeine content of guarana (40–80 mg per gram of extract) [4] is not always stated in packaging and is additional to the listed caffeine content of energy drinks [2]. Hence, the caffeine dose that the patient has consumed may be higher than that the authors have calculated. Guarana is currently thought to have no adverse effects other than potential caffeine toxicity [5]. Second, supplemental taurine has been felt to have potential beneficial effects on the cardiovascular system via mediating redox stress [6]. Therefore, despite authors’ suggestion, the potential effect of taurine to explain the detrimental effects of Redbull and Monster consumption on cardiovascular system seems unlikely. Third, it has been shown that 1 h after consumption of an energy drink whose components were similar to Redbull and Monster , there were cardiovascular changes characterized by increase in platelet aggregation, impairment of endothelial function, and increase in blood pressure. It has been postulated that glucuronolactone may contribute to these cardiovascular changes [7]. Thus, it is possible that in addition to caffeine-induced coronary artery vasospasm, increased platelet aggregation and reduced endothelial functionality have contributed to the observed acute myocardial ischemia in this patient. Regarding other ingredients in Redbull and Monster , it is important to note that there are no data to date about the impact of L-Carnitine on cardiovascular events [2]. In addition, it has been stated that ginseng is present in energy drinks below common daily doses, and has not been reported to be toxic [3, 8]. Thanks for this interesting case report.