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

BACKGROUND: 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. AIM: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.