The authors selected, from a general sample of 3525 cardiopathic patients treated with 2 g daily of L-carnitine during 1 year, 220 stable effort angina TNT-responder patients, presenting more than 15 anginal episodes per month; moreover, other 59 anginal patients in congestive heart failure have been taken into account. The evaluation of the results obtained in these samples has been done in parallel with the ones of cardiopathic patients studied in 2 multicentric trials carried out, according to a very similar protocol, in Switzerland (148 patients treated at the same posology for 6 months) and Germany (143 patients, 3 months of treatment). The analysis of the three trials showed net reduction of both rate of anginal episodes and therapeutic use of nitrates, substantiated by improvement of physical performance (demonstrated by ergometric test in the German trial) as well as of the quality of life (the Swiss trial). Furthermore, from the general sample of 3525 patients the authors selected 737 subjects with clearly pathological levels of plasma cholesterol, in order to evaluate the effect of L-carnitine treatment on lipidemic parameters; after 12 months of administration only 282 patients showed abnormal levels of cholesterolemia. Analysis of the results of the three trials and a review of the literature on carnitine identify the compound as a fundamental drug for the treatment of patients with myocardial ischemia.