




































Mandumpala & Kumar                                                                  Energy Drinks and Long term Cardiovascular risks 

Vol 1 | Issue 3 | Oct – Dec 2022                                                                                      Indian J Pharm Drug Studies | 88  

Review Article 

Potential effects of excessive Energy drinks consumption in young people on 

long-term cardiovascular risks  

Akhil Kumar1, Janice Jacson Mandumpala2  

From, 1,2Pharm D intern, Department of Pharmacy Practice, 1Jayamukhi College of Pharmacy, Telangana,  2Nirmala College of 

Pharmacy, Muvattupuzha, Kerala, India. 

Correspondence to: Janice Jacson Mandumpala, Pharm D intern, Department of Pharmacy Practice, Nirmala College of Pharmacy, 

Muvattupuzha, Kerala, India, Pin – 686661 Email: janice.jacson@gmail.com  

ABSTRACT 

Energy drinks have been recently associated with adverse outcomes. One of the prominent issues being considered is the link between 

the risk of developing cardiovascular diseases and energy drink consumption. The increasing concentration of caffeine accompanied by 

sugars, taurine, etc. are mainly responsible for these risks. In the long term, the children and the youth are vulnerable to the dangers of 

energy drink consumption. Attention needs to be given to the adverse cardiovascular effects in this population. Regulatory actions and 

future restrictions on the sale and consumption of these drinks can bring about positive attitudes in the minds of people and influence 

their patterns of energy drink consumption. This review gives a comprehensive picture of the various aspects related to energy drinks 

consumption, cardiovascular risks, risk in the younger population and regulatory actions to be implemented. 

Keywords: Energy drinks, cardiovascular diseases, Risk, Youth

literature review is a critical analysis of academic 

publications and scientific articles in order to 

comprehend theories and thoughts regarding a specific 

issue. The goal of the literature review is to explore different 

literature pertaining to a subject, collect and synthesise 

information, conduct a critical analysis of the obtained data to 

discover recent knowledge and gaps, and summarize the 

literature [1]. In this review of literature, the aim of the 

researcher is to collect and synthesize information from various 

secondary resources about the adverse effects of consuming 

large amounts of energy drinks among the young generations 

and shed light on its long-term cardiovascular risk potential.  

Energy drinks appeared in Europe and Asia in the 1960s. The 

introduction of 'Red Bull' in Austria in 1987 and in the United 

States in 1997 resulted in a massive spike in the sale of high 

caffeine content energy drinks. As they have grown in 

popularity, their consumption has risen at an exponential rate. 

Energy drinks have risen in popularity as evidenced by their 

increased consumption patterns in the younger population. 

Young males primarily consume energy drinks for, 

psychoactive, stimulant and performance-enhancing drug 

effects [2, 3].   

There are no specific restrictions or limitations on the sale 

and consumption of energy drinks making them accessible to all 

age groups. Though there are extensive studies suggesting a 

positive association between consumption of energy drinks and 

improved athletic performance there are cardiovascular risks 

associated with it. Young, caffeine-deficient or caffeine-

sensitive pregnant women, competitive athletes, and people 

with underlying cardiovascular disease are the most vulnerable 

to these risks [4].   

Energy Drinks  

Role of ingredients: Caffeine and taurine are the two most 

common stimulant components in energy drinks. Caffeine has 

always been attributed to the majority of the adverse 

consequences associated with energy drink intake. Caffeine is 

found in energy drinks in quantities ranging from 70 to 200 mg 

per 500 mL can. It stimulates the sympathetic system indirectly 

by binding to the adenosine receptor/Gprotein on the surfaces of 

cardiac cells. This results in an increase in circulating 

noradrenaline and adrenaline levels. Noradrenaline raises blood 

pressure and heart rate, stimulates the release of glucose from 

energy stores and improves blood supply to skeletal muscle. The 

positive inotropic and chronotropic effects on the cardiovascular 

system are due to these related mechanisms. Caffeine in large 

quantities, especially in younger people, can disturb nervous 

system functioning, just as high sugar content makes an 

individual prone to overweight, obesity, dental erosion, and 

tooth decay. Caffeine's effects are highly dependent on the dose 

consumed, and individual responses are quite variable, a dose of 

A 



Mandumpala & Kumar                                                                  Energy Drinks and Long term Cardiovascular risks 

Vol 1 | Issue 3 | Oct – Dec 2022                                                                                      Indian J Pharm Drug Studies | 89  

50-100 mg can be stimulating, while a dose of 500 mg can lead 

to serious health issues. Furthermore, athletes consuming 

energy drinks prior to extended physical activity should be 

warned about caffeine's diuretic effect that can exacerbate 

dehydration caused by sweat [5].   

Taurine is a sulfur-containing amino acid that influences a 

variety of biological and physiological processes in the human 

body, including important cardiovascular effects, platelet 

aggregation, and central nervous system neuromodulation. 

Animal studies have suggested that taurine can lengthen the QT 

interval in a dose-dependent manner. Sugars in energy drinks 

can also affect the cardiovascular system as consuming dietary 

calories is known to cause an increase in heart rate, cardiac 

output, and pulmonary ventilation rate. Sucrose, glucose and 

high fructose corn syrup are easily absorbed sugars that are 

available in large quantities in energy drinks, which are the 

sources of ‘rapid boosters’. Ginkgo biloba, guarana, ginseng, 

theophylline vitamins, L-carnitine, etc. are also among the other 

constituents present in variable concentrations in energy drinks 

[6, 7]. 

Cardiovascular Effects of Energy Drinks  

Myocardial infarction, aortic dissection, arrhythmias, QT 

prolongation, and sudden death are the cardiovascular adverse 

events linked to caffeinated energy drink use and the most 

common adverse being arrhythmias Hypertensive patients and 

hypertension-risk groups, such as patients with kidney failure, 

morbidly obese individuals, patients with valvular heart disease, 

pregnant women, and patients with hypertension-related 

complications or congenital or acquired vascular abnormalities, 

can face cardiovascular risk from energy drink consumption [8].  

Risk of supraventricular and ventricular arrhythmias: 

Caffeine promotes cardiac adenosine, which inhibits cardiac 

fibroblast formation in vitro and hence hinders remodelling after 

myocardial infarction, which may be a contributing factor in the 

development of atrial fibrillation. Caffeine is pro arrhythmic at 

very high doses because it increases intracellular calcium, which 

facilitates atrial automaticity and post depolarization-induced 

triggered activity. Energy drinks have also been linked to 

ventricular arrhythmias and sudden cardiac death in some cases 

[9–11]. It is recommended that healthy people restrict their 

energy drink use to one per day. Mixing energy drinks with 

alcohol is also a potential source of threat as it can lead to 

synergistic proarrhythmic effects [12]. Thus, amplifying the 

arrhythmic activity and increasing the risk of adverse 

cardiovascular events.  

Risk of prolonged QT interval: Ingestion of caffeine poses a 

risk of QT interval prolongation. Other energy drink 

constituents, like ginseng, have been associated with QT 

prolongation in a young patients, leading to torsades de pointes 

[13]. Ephedra, have been linked to a variety of cardiovascular 

issues, prompting its removal from the market [14].  

Risk of myocardial ischaemia or infarction: Evidence 

suggests a risk of myocardial infarction in energy drink 

consumers [15]. The plausible explanation for this adverse event 

is the increase in mean arterial blood pressure, increase in 

platelet aggregation and impairment in endothelial function 

after consumption of energy drinks [16]. They all contribute to 

the development of long-term hypertension, increased 

coagulability, sudden cardiac death, cumulative vascular load, 

dyslipidemia, atherosclerosis and other life-threatening 

conditions.  

Other risks: The other uncommon cardiovascular risks 

associated with energy drink consumption are aortic dissection 

and dilated cardiomyopathy. Caffeine-induced elevated blood 

pressure is one likely explanation for energy drinks-related 

aortic dissection. Future studies linking energy drinks 

consumption and aortic dissection are needed [17].  

Energy Drinks and the Younger  

Population: Higher occurrence of energy drinks associated 

with adverse events in children and adolescents is attributed to 

their relative caffeine naivety and elevated levels of caffeine in 

their system. As per the recommendation of the American 

Academy of Pediatrics and the National Federation of State 

High School Associations, consumption of energy drinks is 

prohibited in children and adolescents, its consumption should 

be restricted before, after or during physical activity. The 2015 

Dietary Guidelines Advisory Committee has also addressed the 

threats pertaining to energy drinks consumption, highlighting 

the sensitivity of children and adolescents to the negative health 

effects of caffeine, as well as the scarcity of data on caffeine use 

in this vulnerable cohort [18].  

Table 1: Possible cardiovascular manifestations of energy 

drink abuse in adolescents  

Possible cardiovascular manifestations of energy 

drink abuse in adolescents  

Tachycardia  

Atrial fibrillation or flutter  

Ventricular arrhythmias  

QT prolongation  

ST-segment elevation  

Myocardial infarction  

Hemodynamic failure  

Sudden cardiac death  

Cumulative cardiovascular load  

Effective commercial marketing, peer influence, and a lack 

of knowledge of the possible hazards associated with energy 

drinks consumptions are the few reasons for its increased 

popularity among young adults and adolescents. The propensity 



Mandumpala & Kumar                                                                  Energy Drinks and Long term Cardiovascular risks 

Vol 1 | Issue 3 | Oct – Dec 2022                                                                                      Indian J Pharm Drug Studies | 90  

among young people to use alcohol-mixed energy drinks, 

particularly during social events, is a major public health 

concern. Energy drink consumption can also precipitate the 

onset of substance use disorder in people who are predisposed 

to such tendencies [19]. Also, there are concerns being raised 

about consuming energy drinks with illicit substances like 

marijuana and amphetamines [20].   

It is proven that caffeine administration raises blood pressure 

and lowers heart rate. Similar findings have been reported in 

both pre- and post-pubertal boys and girls. There are gender 

differences in cardiovascular responses to caffeine which 

usually emerge after puberty. The metabolism of caffeine is 

altered by fluctuating steroid hormones that are present during 

the pubertal phase of boys and girls leading to varied 

cardiovascular responses. According to studies, estradiol 

decreases cytochrome P450 function, resulting in an increased 

concentration of caffeine in the systemic circulation. Another 

possible explanation is that these gender differences are linked 

to variations in caffeine consumption patterns as the younger 

population ages. Studies have also documented evidence of 

changes in caffeine metabolism with changes in the phases of 

the menstrual cycle in post-pubertal girls [21]. Caffeine if 

consumed in large quantities can also lead to exacerbation of 

underlying cardiac conditions [22, 23].   

Prevention of Cardiovascular Diseases: Cardiovascular 

diseases are one of the leading causes of mortality globally. Diet 

is a combination of carbohydrates, fats and protein that have an 

impact on human health. The link between nutrition and health 

is complicated, and attempts to delay or prevent chronic 

diseases like cardiovascular diseases are of particular 

importance because chronic diseases, and specifically 

cardiovascular diseases, remain the largest cause of death and 

disability globally [24].   

Cardiovascular prevention should include a multimodal 

behavioural intervention focused on health education, physical 

activity, and psychological risk factors. This critical stage in 

cardiovascular prevention begins with changing one's smoking 

habits. Half of all preventable deaths in smokers are attributable 

to cardiovascular diseases, which are caused by smoking. 

Smoking cessation has been shown to have immediate and long-

term benefits. To achieve the goal of quitting smoking, health 

care practitioners must provide an intensive programme that 

includes professional assistance for improving patients' 

motivation and, in certain cases, pharmacological aids. Regular 

physical activity and aerobic exercise training have also been 

linked to a lower incidence of cardiovascular diseases and 

nonfatal coronary events in both healthy people and those with 

coronary risk factors and cardiac patients.  

A heart-healthy diet plays a crucial role in preventing 

cardiovascular disease. Observational studies provide the 

majority of evidence supporting the impact of healthy eating 

habits on cardiovascular risk.   Saturated fatty acids should 

account for 10% of total energy intake, with polyunsaturated 

fatty acids replacing them as much as possible; transunsaturated 

fatty acids should account for 1% of total energy intake; 200 g 

fruit/day; 200 g vegetables/day; fish at least twice a week; 

alcohol consumption should be limited to two glasses (20 g/day 

alcohol) for men and one glass (20 g/day alcohol) for women.  

The amount of energy consumed should correspond to the 

amount of energy required to achieve a healthy weight.   

Weight loss in overweight (BMI 25–29.9 kg/m2) and obese 

(BMI.30 kg/m2) patients is significant for cardiovascular 

protection since it is linked to improvements in cardiovascular 

risk variables such as blood pressure, dyslipidemia, and insulin 

resistance. Prevention is critical in diabetic patients to lower the 

risk of microvascular and cardiovascular problems. Another 

important goal in the prevention of cardiovascular diseases is 

reducing lipid levels. Increased plasma cholesterol and LDL 

cholesterol, as well as hypertriglyceridemia and low HDL 

cholesterol, are major risk factors for cardiovascular diseases 

[25]. Integration of these preventive methods in conjunction 

with decreased consumption of energy drinks can be a valuable 

strategy. Therefore, practising good cardiovascular risk 

prevention practices can yield better life outcomes, reduce 

economic burden and also decrease the burden on the expanding 

healthcare system.  

Regulatory Requirements 

The Food and Drug Administration (FDA) has primary 

jurisdiction over energy drink safety, labelling, and ingredients. 

State and local governments can exercise jurisdiction over 

public health and safety to control the sale of these products and 

safeguard consumers through their legislatures and agencies 

[26]. Regulatory actions on the manufacturing and sale of high-

energy drinks by the FDA and the Consumer Product Safety 

Commission are needed, considering the serious health issues it 

imposes. In addition to this, medical vigilance can also be 

implemented and health education can be imparted to parents 

and young children about the inherent risks associated with the 

consumption of energy drinks [27]. The rapid introduction of 

caffeine in non-traditional food, beverages and energy drinks 

makes it necessary to implement dietary assessment tools to 

account for evolving caffeine sources and novel components in 

the food supply chain. Energy drinks consumption is associated 

with adverse events, poison centre visits, emergency visits and 

hospitalisations, a systematic collection of these data along with 

an understanding of the various risk factors can be a useful 

source for determining the risk of toxicity among the youth and 

other populations [28].  

Literature Gap  

After a thorough literature review, it can be understood that 

there is a lack of large epidemiological studies that correlate the 



Mandumpala & Kumar                                                                  Energy Drinks and Long term Cardiovascular risks 

Vol 1 | Issue 3 | Oct – Dec 2022                                                                                      Indian J Pharm Drug Studies | 91  

direct association between cardiovascular events and energy 

drink consumption. Evaluation of energy drinks over a long 

period of time and in a systematic manner and reducing overall 

caffeine consumption, particularly among children, should be a 

priority. Future studies exploring the adverse outcomes of 

energy drink consumption, and its interaction with various food 

products other than alcohol and illicit substances are 

recommended. Future studies should reflect on the association 

of other ingredients in energy drinks and their contribution to 

cardiovascular risk. Research should also be extended to 

identify the exact reason that leads to adverse events – rapid 

intake, the volume of intake or intake with other ingredients. 

Individual case reports can be a valuable source to stage a 

platform for formulating a hypothesis, and testing of hypothesis 

on a larger target population can yield valuable scientific results.  

REFERENCES  

1. Paul J, Criado AR. The art of writing literature review: What do we 

know and what do we need to know? Int Bus Rev. 2020, 29: 

10.1016/j.ibusrev.2020.101717 

2. Reissig CJ, Strain EC, Griffiths RR. Caffeinated energy drinks-A 

growing problem. Drug Alcohol Depend. 2009, 99: 

10.1016/j.drugalcdep.2008.08.001 

3. Ehlers A, Marakis G, Lampen A, et al. Risk assessment of energy 

drinks with focus on cardiovascular parameters and energy drink 

consumption in Europe. Food Chem. Toxicol. 2019, 130: 

10.1016/j.fct.2019.05.028 

4. Gutiérrez-Hellín J, Varillas-Delgado D. Energy drinks and sports 

performance, cardiovascular risk, and genetic associations; future 

prospects. Nutrients. 2021, 13: 10.3390/nu13030715 

5. Piccioni A, Covino M, Zanza C, et al. Energy drinks: a narrative 

review of their physiological and pathological effects. Intern. Med. 

J. 2021, 51: 10.1111/imj.14881 

6. Wolk BJ, Ganetsky M, et al. Toxicity of energy drinks. Curr. Opin. 

Pediatr. 2012, 24: 10.1097/MOP.0b013e3283506827 

7. Grasser EK, Miles-Chan JL, Charrière N, et al. Energy drinks and 

their impact on the cardiovascular system: Potential mechanisms. 

Adv. Nutr. 2016, 7: 10.3945/an.116.012526 

8. Basrai M, Schweinlin A, Menzel J, et al. Energy drinks induce 

acute cardiovascular and metabolic changes pointing to potential 

risks for young adults: A randomized controlled trial. J Nutr. 2019, 

149: 10.1093/jn/nxy303 

9. Cannon ME, Cooke CT, McCarthy JS. Caffeine-induced cardiac 

arrhythmia: An unrecognised danger of health food products. Med 

J Aust. 2001, 174: 10.5694/j.1326-5377.2001.tb143404.x 

10. Kaoukis A, Panagopoulou V, Mojibian HR, et al Reverse takotsubo 

cardiomyopathy associated with the consumption of an energy 

drink. Circulation. 2012, 125: 

10.1161/CIRCULATIONAHA.111.057505 

11. Rottlaender D, Motloch LJ, Reda S, et al. Cardiac arrest due to long 

QT syndrome associated with excessive consumption of energy 

drinks. Int J Cardiol. 2012, 158: 10.1016/j.ijcard.2011.10.017 

12. Enriquez A, Frankel DS. Arrhythmogenic effects of energy drinks. 

J. Cardiovasc. Electrophysiol. 2017, 28: 10.1111/jce.13210 

13. Jonjev ZS, Bala G. High-energy drinks may provoke aortic 

dissection. Coll Antropol. 2013, 37 Suppl 2. 

14. Fontanarosa PB, Rennie D, DeAngelis CD. The Need for 

Regulation of Dietary Supplements - Lessons from Ephedra. 

JAMA. 2003, 289: 10.1001/jama.289.12.1568  

15. Berger AJ, Alford K: Cardiac arrest in a young man following 

excess consumption of caffeinated ‘energy drinks’. Med J Aust. 

2009, 190: 10.5694/j.1326-2009.tb02263.x 

16. Worthley MI, Prabhu A, De Sciscio P, et al Detrimental Effects of 

Energy Drink Consumption on Platelet and Endothelial Function. 

Am J Med. 2010, 123: 10.1016/j.amjmed.2009.09.013 

17. Mangi MA, Rehman H, Rafique M, et al. Energy Drinks and the 

Risk of Cardiovascular Disease: A Review of Current Literature. 

Cureus. Published Online First: 2017. 10.7759/cureus.1322 

18. Higgins JP, Babu K, Deuster PA, et al. Energy Drinks: A 

Contemporary Issues Paper. Curr Sports Med Rep. 2018, 17: 

10.1249/JSR.0000000000000454 

19. Arria AM, Caldeira KM, Kasperski SJ, et al. Increased alcohol 

consumption, nonmedical prescription drug use, and illicit drug use 

are associated with energy drink consumption among college 

students. J Addict Med. 2010, 4: 

10.1097/ADM.0b013e3181aa8dd4 

20. Trapp GSA, Allen KL, O’Sullivan T, et al. Energy drink 

consumption among young Australian adults: Associations with 

alcohol and illicit drug use. Drug Alcohol Depend. 2014, 134: 

10.1016/j.drugalcdep.2013.09.006 

21. Temple JL, Ziegler AM, Graczyk A, et al. Cardiovascular 

responses to caffeine by gender and pubertal stage. Pediatrics. 

2014, 134: 10.1542/peds.2013-3962 

22. Seifert SM, Schaechter JL, Hershorin ER, et al. Health effects of 

energy drinks on children, adolescents, and young adults. 

Pediatrics. 2011, 127: 10.1542/peds.2009-3592 

23. De Sanctis V, Soliman N, Soliman AT, et al. Caffeinated energy 

drink consumption among adolescents and potential health 

consequences associated with their use: A significant public health 

hazard. Acta Biomed. 2017, 88: 10.23750/abm.v88i2.6664 

24. Badimon L, Chagas P, Chiva-Blanch G: Diet and Cardiovascular 

Disease: Effects of Foods and Nutrients in Classical and Emerging 

Cardiovascular Risk Factors. Curr Med  Chem.  2017,  26: 

10.2174/0929867324666170428103206 

25. Kurtz JA, Van Dusseldorp TA, Doyle JA, et al. Taurine in sports 

and exercise. J. Int. Soc. Sports Nutr. 2021, 18: 10.1186/s12970-

021-00438-0 

26. Pomeranz JL, Munsell CR, Harris JL Energy drinks: An emerging 

public health hazard for youth. J Public Health Policy. 2013, 34: 

10.1057/jphp.2013.6 

27. Chrysant SG, Chrysant GS. Cardiovascular complications from 

consumption of high energy drinks: Recent evidence. J. Hum. 

Hypertens. 2015, 29: 10.1038/jhh.2014.47 

28. Harris JL, Munsell CR. Energy drinks and adolescents: What’s the 

harm? Nutr Rev. 2015, 73: 10.1093/nutrit/nuu061  

 

How to cite this article: Akhil Kumar, Janice Jacson 

Mandumpala.  Potential effects of excessive Energy drinks 

consumption in young people on long-term cardiovascular 

risks.  Indian J Pharm Drug Studies. 2022: 1(3) 88-91. 

Funding: None                   Conflict of Interest: None Stated 

 


