Therapeutic potential of L-carnitine in coronary artery disease: a systematic review

Coronary artery disease (CAD) persists as a major global health burden, contributing significantly to both morbidity and mortality rates worldwide, mostly attributable to atherosclerosis and oxidative stress. L-carnitine (LC), a natural derivative of amino acid, plays a critical role in mitochondrial fatty acid transport and has demonstrated potential antioxidant as well as anti-inflammatory effects.

This review aims to provide an integrated synthesis that bridges mechanistic evidence (anti-inflammatory, antioxidant) with clinical outcomes (mortality, arrhythmias) for LC supplementation in CAD, while critically appraising inconsistencies across the literature (e.g., heart failure, reinfarction).

A systematic literature search was conducted in PubMed and Google Scholar databases until July 2025. Studies, including animal studies, case reports, cross-sectional studies, observational studies, retrospective analysis, randomized controlled trials, systematic review and meta-analyses, that investigating the effects of L-carnitine on cardiac function, oxidative stress, inflammation, and mortality in CAD patients were included. Articles that were not within the scope of the study, non-English papers, and those without translations were excluded. A total of 21 studies were identified based on the inclusion criteria.

Across mechanistic endpoints, LC was associated with reductions in inflammatory markers, oxidative stress indices, and cardiac injury biomarkers, with several trials noting improvements in left-ventricular function and lipid profiles. Regarding clinical endpoints, meta-analyses showed reductions in the incidence of all-cause mortality, ventricular arrhythmia, and anginal episodes. In contrast, results were inconsistent regarding heart failure and myocardial reinfarction outcomes.

L-carnitine supplementation may offer cardioprotective benefits in CAD patients; however, given the inconsistent results regarding certain clinical endpoints, further large-scale, long-term randomized trials are required.