Melatonin and Cardiovascular Outcomes
Current evidence does not support the routine use of melatonin for improving cardiovascular outcomes in older adults with cardiovascular disease, as there are no high-quality clinical trials demonstrating benefits on mortality, major adverse cardiovascular events, or quality of life in this population.
Evidence Quality and Limitations
The available evidence on melatonin's cardiovascular effects consists primarily of mechanistic studies, small clinical trials, and observational data—none of which meet the standard for guideline-level recommendations in older adults with established cardiovascular disease 1, 2, 3.
Major cardiovascular guidelines from the American Heart Association, American College of Cardiology, and American Geriatrics Society do not include melatonin as a recommended therapy for secondary prevention of cardiovascular disease 4.
What the Research Shows (But Doesn't Prove)
Potential Mechanisms Without Clinical Validation
Melatonin demonstrates antioxidant and free radical scavenging properties in laboratory studies, which theoretically could protect against cardiovascular injury 1, 2.
Small studies suggest melatonin may reduce blood pressure by 10-20 mmHg through mechanisms including catecholamine reduction and smooth muscle relaxation 5.
Observational data indicate patients with coronary heart disease have lower melatonin production rates, particularly those at higher risk for myocardial infarction 5.
A small Russian study (170 patients, mean age 64) showed potential anti-ischemic effects when melatonin was added to standard therapy, but this lacks validation in rigorous randomized controlled trials 6.
Critical Gap in Evidence
The fundamental problem is that none of these studies demonstrate improved outcomes that matter most: reduced mortality, fewer heart attacks or strokes, or better quality of life in older adults with cardiovascular disease 1, 2, 3.
Clinical Context for Older Adults
Polypharmacy Concerns Take Priority
The American Geriatrics Society and American College of Cardiology emphasize that polypharmacy leads to poor outcomes in older adults, making deprescribing and reduction of unnecessary medications a top priority 4.
Adding melatonin to an already complex medication regimen in older adults with cardiovascular disease contradicts evidence-based principles of minimizing polypharmacy without proven benefit 4.
Older adults with cardiovascular disease already face challenges with medication adherence, adverse drug events, and drug-drug interactions—adding unproven therapies compounds these risks 4.
What Actually Works in This Population
The American Heart Association guidelines for secondary prevention in older adults with cardiovascular disease prioritize proven therapies 4:
- Blood pressure control (with evidence from HYVET trial showing 39% reduction in fatal stroke and 21% reduction in all-cause mortality in adults ≥80 years) 4
- Antiplatelet therapy
- Statins for lipid management
- Beta-blockers and ACE inhibitors post-myocardial infarction
- Anticoagulation for atrial fibrillation
Practical Recommendation
Do not prescribe melatonin for cardiovascular disease prevention or treatment in older adults. Focus instead on optimizing evidence-based cardiovascular medications that have demonstrated mortality and morbidity benefits in this population 4.
When Melatonin Might Be Appropriate
If an older adult with cardiovascular disease has a separate indication for melatonin (such as circadian sleep disorders or insomnia), this should be addressed independently of cardiovascular considerations, recognizing that any cardiovascular benefit remains unproven 1, 2.
Key Pitfalls to Avoid
Do not substitute melatonin for proven cardiovascular therapies based on mechanistic rationale or small studies 4.
Do not add melatonin to complex medication regimens without clear indication, as this increases polypharmacy burden without demonstrated benefit 4.
Do not assume "natural" or "well-tolerated" means beneficial—the absence of proven harm does not equal proven benefit, especially when opportunity costs include optimizing truly effective therapies 4.