Energy Drinks as the Legal Cocaine? A Comparative Review of Cardiac Physiopathological and Histopathological Patterns

Energy drinks (EDs), widely consumed for their stimulant effects, typically contain caffeine alongside taurine, guarana, and other bioactive compounds. While generally regarded as safe, growing evidence links chronic EDs consumption to significant cardiovascular risks. Caffeine, the primary active ingredient, acts through adenosine receptor antagonism and increased calcium release, potentially provoking arrhythmias and myocardial stress. Taurine and other additives further influence cardiac excitability and contractility. This systematic review, conducted under PRISMA 2020 guidelines, investigated the cardiac histopathological consequences of chronic EDs use. A literature search spanning 2021 to March 2025 across PubMed, Google Scholar, and Scopus identified studies reporting EDs-related cardiac effects. Data extraction and analysis revealed consistent associations with QTc prolongation, atrial and ventricular arrhythmias, myocardial infarction, Takotsubo cardiomyopathy, and hypertensive episodes-even in young, healthy individuals. Animal studies support these findings, showing myocardial necrosis, myofiber disarray, mitochondrial damage, and inflammation, particularly when EDs are combined with alcohol. Notably, similarities between EDs and cocaine emerged, including shared mechanisms involving ion channel blockade, sympathetic overactivation, vasoconstriction, and prothrombotic states. Chronic use of either substance can result in structural heart damage and remodelling. Although EDs and cocaine differ in legal status and potency, their overlapping cardiovascular effects warrant greater clinical awareness and public education. Excessive EDs consumption poses a real cardiotoxic risk, especially in vulnerable populations, underscoring the need for further human research and potential regulatory consideration.