Letter to Editor: Potential Use of Meldonium as Supportive Treatment in Lifestyle Diseases

Addressing Knowledge Gaps and the Need for Further Research

Abstract

Meldonium, a drug more familiar in the sports world than in clinical medicine, acts as a structural analog of gamma-butyrobetaine and influences carnitine metabolism by inhibiting gamma-butyrobetaine hydroxylase. This results in reduced carnitine levels, decreased fatty acid β-oxidation, and increased glucose utilization. Such metabolic shifts are advantageous in conditions of low oxygen availability, making meldonium a substance of interest for its potential cardioprotective effects. Animal studies suggest that meldonium can reduce infarct size, enhance cardiac recovery post-ischemia, and improve cardiac function by attenuating ventricular dysfunction. Additionally, meldonium has demonstrated beneficial effects on glucose metabolism and endothelial function in diabetes models. Recent research also highlights its potential in mitigating neuronal damage and enhancing survival in high-altitude brain injury models. Despite these promising findings, human clinical trials are necessary to confirm meldonium’s efficacy and safety for treating major lifestyle diseases such as heart failure, type 2 diabetes, and ischemic heart disease. The current evidence base is limited by small-scale studies and outdated treatment protocols. Thus, large-scale, double-blind randomized trials are essential to clarify the drug’s therapeutic potential and to address significant gaps in knowledge surrounding its clinical use.