In Canada, Caffeinated Energy Drinks (CEDs) currently sold under Temporary Marketing Authorizations must meet strict eligibility criteria. These criteria, which include compositional and labelling requirements, were developed based on the outcome of a health risk assessment conducted by Health Canada (HC) in 2013. HC updated its assessment by reviewing new information with the focus on potential cardiovascular (CV) effects associated with the consumption of CEDs available for sale in Canada. Due to limited data on CED consumption among Canadians to derive accurate exposure information, the composition of a typical CED was characterized to assess the potential effects of single ingredients and synergistic interactions between ingredients, on the cardiovascular system. Surveillance data on potential adverse effects related to CED consumption was also analysed. After extensive review, HC’s updated assessment confirms the current risk management approach for CEDs is health protective for Canadian consumers, including the potential for cardiovascular effects. The available evidence supports that moderate consumption (up to 500 ml per day) of a typical CED authorized for sale in Canada is safe for the general population of healthy adults and adolescents. It also re-confirms vulnerable sub-populations (i.e., children, pregnant and/or breastfeeding women, and caffeine-sensitive individuals) should not consume CEDs. NOVELTY: • Consumption up to 500 ml per day of a typical CED is not associated with an increased risk of cardiovascular effects • Children, pregnant and/or breastfeeding women, and caffeine-sensitive individuals should not consume CEDs

The impact of caffeinated energy drinks (CED) on the cardiovascular (CV) response to exercise has not been well described. A systematic review and meta-analysis (MA) was conducted on the acute effects of CEDs on CV responses during dynamic, aerobic exercise in 296 healthy adult males (224) and females (72) in 21 randomized controlled trials. During exercise, there was an increase in heart rate (HR) (mean difference (MD), 2.86 bpm, 95% CI, 2.39-3.34 bpm, I2=0%, p<0.00001), and systolic blood pressure (SBP) (MD, 9.02 mmHg, 95% CI, 4.25-13.79 mmHg, I2= 0%, p=0.0002) with consumption of CEDs, compared to controls, but diastolic blood pressure was similar. Insufficient data was available to evaluate rate pressure product (HR X SBP) and exercise-induced arrhythmia. Though changes to HR during exercise were modest, the significant increase in exercise SBP highlights the importance of directly assessing CV effects of CEDs with exercise, especially in individuals prone to hypertension. Novelty Bullets: 1. Exercise SBP in healthy adults is significantly increased during exercise with the consumption of CEDs compared to control, despite limited data. 2. The direct assessment of CV effects of CEDs with exercise highlights the particular relevance to individuals prone to hypertension.