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Red Bull®: Red flag or red herring?

2017; Elsevier BV; Volume: 231; Linguagem: Inglês

10.1016/j.ijcard.2016.12.181

1874-1754

Peter J. Schwartz, Federica Dagradi,

Mycotoxins in Agriculture and Food

One of the most disquieting events in modern medicine was the realization that a huge variety of drugs used also for non-life-threatening disorders such as antihistaminics or antibiotics - all blockers of the IKr current -, could trigger life-threatening cardiac arrhythmias resulting in drug-induced long QT syndrome (LQTS) [ 1 Roden D.M. Drug-induced prolongation of the QT interval. N. Engl. J. Med. 2004; 350: 1013-1022 Crossref PubMed Scopus (1645) Google Scholar , 2 Schwartz P.J. Woosley R.L. Predicting the unpredictable: drug-induced QT prolongation and torsades de pointes. J. Am. Coll. Cardiol. 2016; 67: 1639-1650 Crossref PubMed Scopus (177) Google Scholar ]. We have recently demonstrated that almost one-third of drug-induced LQTS occurs in subjects carrying disease-causing mutations for congenital LQTS [ [3] Itoh H. Crotti L. Aiba T. Spazzolini C. Denjoy I. Fressart V. Hayashi K. Nakajima T. Ohno S. Makiyama T. Wu J. Hasegawa K. Mastantuono E. Dagradi F. Pedrazzini M. Yamagishi M. Berthet M. Murakami Y. Shimizu W. Guicheney P. Schwartz P.J. Horie M. The genetics underlying acquired long QT syndrome. Impact on management. Eur. Heart J. 2016; 37: 1456-1464 Crossref PubMed Scopus (123) Google Scholar ], thus confirming earlier observations [ 4 Napolitano C. Schwartz P.J. Brown A.M. Ronchetti E. Bianchi L. Pinnavaia A. Acquaro G. Priori S.G. Evidence for a cardiac ion channel mutation underlying drug-induced QT prolongation and life-threatening arrhythmias. J. Cardiovasc. Electrophysiol. 2000; 11: 691-696 Crossref PubMed Scopus (284) Google Scholar , 5 Yang P. Kanki H. Drolet B. Yang T. Wei J. Viswanathan P.C. Hohnloser S.H. Shimizu W. Schwartz P.J. Stanton M. Murray K.T. Norris K. George Jr., A.L. Roden D.M. Allelic variants in long QT disease genes in patients with drug-associated torsades de pointes. Circulation. 2002; 105: 1943-1948 Crossref PubMed Scopus (482) Google Scholar ]. The emerging concept is that these arrhythmic events are not occurring randomly but are more likely to develop in apparently healthy individuals who, however, have a genetic predisposition to react to, say, IKr blockers. However, it was totally unforeseen that also substances that we may eat or drink could have similar potentially dangerous effects.