Melatonin and Cardiovascular Outcomes in Older Adults

Evidence-Based Recommendations

The American Heart Association, American College of Cardiology, and American Geriatrics Society do not recommend melatonin as a therapy for secondary prevention of cardiovascular disease in older adults 1, 2, 3, 4.
The American Geriatrics Society and American College of Cardiology prioritize minimizing polypharmacy in older adults, making deprescribing and reduction of unnecessary medications a top priority 1, 2, 5.
Adding melatonin to an already complex medication regimen in older adults with cardiovascular disease contradicts evidence-based principles of minimizing polypharmacy without proven benefit 1, 2.
The American Heart Association guidelines for secondary prevention in older adults with cardiovascular disease prioritize proven therapies, including blood pressure control, antiplatelet therapy, statins for lipid management, beta-blockers and ACE inhibitors post-myocardial infarction, and anticoagulation for atrial fibrillation 3, 4, 5.
Blood pressure control has been shown to reduce fatal stroke by 39% and all-cause mortality by 21% in adults ≥80 years 3, 4.

The American Geriatrics Society and American College of Cardiology recommend focusing on optimizing evidence-based cardiovascular medications that have demonstrated mortality and morbidity benefits in older adults 1, 2, 3, 4.
Melatonin should not be prescribed for cardiovascular disease prevention or treatment in older adults, but may be considered for separate indications such as circadian sleep disorders or insomnia 1, 2.
Substituting melatonin for proven cardiovascular therapies or adding it to complex medication regimens without clear indication should be avoided 1, 3, 5.