Curcuma Xanthorrhiza, Curcumin, High-sensitivity C-reactive Protein, Hs-CRP, Malondialdehyde, ST Elevation Myocardial Infarction (STEMI)
Conditions
Keywords
Curcumin, Piperine, Turmeric (Curcuma Xanthorrhiza), Piper nigrum, ST Elevation Myocardial Infarction, Primary Percutaneous Coronary Intervention (PPCI), Oxidative Stress, Inflammation, High-sensitivity C-Reactive Protein, Malondialdehyde, Antioxidants, Anti-Inflammatory Agents
Brief summary
This study aims to evaluate whether supplementation with a combination of curcumin and piperine can help reduce inflammation and oxidative stress in patients who have experienced a heart attack called ST-Elevation Myocardial Infarction (STEMI) and are undergoing a procedure known as primary percutaneous coronary intervention (PPCI). Curcumin, a natural compound from turmeric, is known for its antioxidant and anti-inflammatory effects, but it is not easily absorbed by the body. Piperine, a compound from black pepper, can improve curcumin absorption. By combining the two, we hope to maximize their potential benefits. The study will measure markers of inflammation (high-sensitivity C-reactive protein, hsCRP) and oxidative stress (malondialdehyde, MDA) at three time points: before treatment, shortly after the PPCI procedure, and after 28 days of supplementation. The main question is whether curcumin-piperine supplementation can provide additional protection against inflammation and oxidative stress compared to a placebo, potentially supporting recovery and reducing the risk of future heart problems.
Detailed description
This randomized, double-blind, placebo-controlled clinical trial investigates the effects of combined curcumin and piperine supplementation on systemic inflammation and oxidative stress in patients with ST-Elevation Myocardial Infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Curcumin, the principal curcuminoid derived from Curcuma xanthorrhiza or Curcuma longa, has demonstrated anti-inflammatory and antioxidant properties in preclinical and clinical studies. However, its oral bioavailability is limited due to poor absorption and rapid metabolism. Piperine, an alkaloid from Piper nigrum, enhances curcumin's bioavailability through inhibition of hepatic and intestinal glucuronidation. Participants are randomized to receive either curcumin-piperine supplementation (390 mg curcumin + 20 mg piperine daily) or matched placebo for 28 consecutive days post-PPCI. Biomarkers of inflammation (high-sensitivity C-reactive protein, hsCRP) and oxidative stress (malondialdehyde, MDA) are assessed at three predefined time points: baseline (pre-intervention), 48-72 hours after PPCI, and at day 28 post-supplementation. The primary objective is to determine whether curcumin-piperine supplementation significantly attenuates the rise in hsCRP and MDA levels compared to placebo. Secondary objectives include evaluating the temporal pattern of biomarker changes and assessing the tolerability and safety profile of the supplementation in the acute and subacute phases post-STEMI. The findings may provide evidence for adjunctive nutraceutical therapy to improve post-MI recovery by targeting inflammatory and oxidative stress pathways.
Interventions
DIETARY_SUPPLEMENTCurcumin plus Piperine
A loading dose of 2 capsules (each containing 390 mg curcumin + 20 mg piperine) is administered orally prior to PPCI, followed by maintenance of 1 capsule daily until day 28. Oral administration of standardized curcumin extract (390 mg) combined with piperine (20 mg), given twice daily for 28 days in addition to standard-of-care therapy for STEMI patients undergoing primary percutaneous coronary intervention (PPCI). The curcumin-piperine formulation is used to enhance bioavailability and anti-inflammatory effects, aiming to improve post-MI recovery and reduce oxidative stress.
OTHERPlacebo capsules
A loading dose of 2 capsules (each containing saccarum lactic) is administered orally prior to PPCI, followed by maintenance of 1 capsule daily until day 28. Oral administration of standardized placebo capsule, given twice daily for 28 days in addition to standard-of-care therapy for STEMI patients undergoing primary percutaneous coronary intervention (PPCI).
Sponsors
Dr. Kariadi Hospital Semarang, indonesia
Universitas Diponegoro
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Masking description
Participants, care providers, investigators, and outcomes assessors are unaware of group allocation. Placebo capsules are identical in appearance, size, and packaging to the curcumin-piperine capsules to maintain blinding. Randomization codes are kept by an independent pharmacist until data analysis is complete. An independent pharmacist and data analyst are also masked to group allocation until database lock. Laboratory personnel performing biomarker analyses (hsCRP and MDA) are blinded to treatment assignment. Randomization codes are securely stored and only accessible to an independent statistician not involved in patient care or outcome assessment.
Intervention model description
Participants are randomized in a 1:1 ratio to receive either curcumin-piperine supplementation or matching placebo, administered daily for 28 days following primary percutaneous coronary intervention for STEMI. Both groups are followed in parallel for the same duration, with biomarker measurements taken at baseline, 48-72 hours post-procedure, and at day 28.
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Adults aged 18 to 80 years. * Confirmed diagnosis of ST-Elevation Myocardial Infarction (STEMI). Symptom onset within 12 hours, or within 12 to 72 hours in cases with an indication for primary percutaneous coronary intervention (PPCI). * Receiving standard-of-care medical therapy according to current guidelines, including: Dual antiplatelet therapy. Angiotensin-Converting Enzyme Inhibitors (ACE-i) or Angiotensin Receptor Blockers (ARBs). Statins. Beta-blockers.
Exclusion criteria
* Regular prior use of curcumin supplementation. * Hemodynamic instability or severe dyspnoea with clinical signs of congestion (elevated jugular venous pressure, pulmonary rales affecting \>1/3 of lung fields, hepatomegaly, ascites, or peripheral oedema). * History of prior myocardial infarction, previous percutaneous coronary intervention, or coronary artery bypass graft surgery. * Known hypersensitivity to curcumin or piperine. * Active malignancy. * Chronic infections (e.g., hepatitis, tuberculosis, or HIV). * Estimated glomerular filtration rate (eGFR) \<30 mL/min/1.73 m² or rapidly declining renal function.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change from Baseline in Serum High-Sensitivity C-Reactive Protein (hsCRP) at Day 28 | Baseline (pre-intervention), within 48-72 hours post-PPCI and after 28 days of intervention | Mean change (Δ) in serum hsCRP from baseline to Day 28, expressed in mg/L. Lower values indicate less systemic inflammation. The prespecified metric is group-wise mean change and between-group difference in mean change. |
| Change from Baseline in Malondialdehyde (MDA) at Day 28 | Baseline (pre-intervention), within 48-72 hours post-PPCI and after 28 days of intervention | Mean change (Δ) in serum MDA concentration from baseline to Day 28, expressed in nmol/mL. Lower values indicate less lipid peroxidation/oxidative stress. The prespecified metric is group-wise mean change and between-group difference in mean change. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Liver Function | Baseline and after 28 days of intervention | To assess changes in liver enzyme activity (ALT and AST) as a marker of hepatic safety and potential hepatoprotective effect of curcumin-piperine supplementation. Unit of Measure: U/L. |
| Change in Serum Creatinine Levels | Baseline and after day 28 of intervention | Serum creatinine will be measured to evaluate kidney function at baseline and after 28 days of supplementation. Unit of Measure: mg/dL. |
| Change in Estimated Glomerular Filtration Rate (eGFR) | Baseline and after day 28 of intervention | eGFR will be calculated using the CKD-EPI formula to assess kidney function at baseline and after 28 days of supplementation. Unit of Measure: mL/min/1.73 m². |
Countries
Indonesia
Outcome results
None listed