Oral curcumin in elective abdominal aortic aneurysm repair: a multicentre randomized controlled trial

Amit X Garg; P J Devereaux; Andrew Hill; Manish Sood; Bharat Aggarwal; Luc Dubois; Swapnil Hiremath; Randolph Guzman; Vikram Iyer; Matthew James; Eric McArthur; Louise Moist; George Ouellet; Chirag R Parikh; Virginia Schumann; Sumit Sharan; Heather Thiessen-Philbrook; Sheldon Tobe; Ron Wald; Michael Walsh; Matthew Weir; Neesh Pannu; Curcumin AAA AKI Investigators

doi:10.1503/cmaj.180510

Oral curcumin in elective abdominal aortic aneurysm repair: a multicentre randomized controlled trial

CMAJ. 2018 Oct 29;190(43):E1273-E1280. doi: 10.1503/cmaj.180510.

Authors

Amit X Garg¹, P J Devereaux², Andrew Hill², Manish Sood², Bharat Aggarwal², Luc Dubois², Swapnil Hiremath², Randolph Guzman², Vikram Iyer², Matthew James², Eric McArthur², Louise Moist², George Ouellet², Chirag R Parikh², Virginia Schumann², Sumit Sharan², Heather Thiessen-Philbrook², Sheldon Tobe², Ron Wald², Michael Walsh², Matthew Weir², Neesh Pannu²; Curcumin AAA AKI Investigators

Affiliations

¹ Departments of Medicine (Garg, McArthur, Moist, Schumann, Thiessen-Philbrook, Weir), of Epidemiology and Bio-statistics (Garg, Dubois, Moist, Weir) and of Surgery (Dubois), Western University, London, Ont.; Departments of Health Research Methods, Evidence, and Impact (Devereaux, Walsh), of Medicine (Devereaux, Walsh) and of Surgery (Iyer), McMaster University, Hamilton, Ont.; Departments of Surgery (Hill) and of Medicine (Sood, Hiremath), University of Ottawa, Ottawa, Ont.; Department of Experimental Therapeutics, Cancer Medicine and Immunology (Aggarwal), The University of Texas MD Anderson Cancer Center, Houston, Tex.; Department of Surgery (Guzman), University of Manitoba, Winnipeg, Man.; Department of Medicine (James), University of Calgary, Calgary, Alta.; Faculté de médecine (Ouellet), Université de Montréal, Montréal, Que.; Program of Applied Translational Research, Department of Medicine (Parikh), and Section of Nephrology (Parikh), Yale University School of Medicine, New Haven, Conn.; Department of Anesthesia (Sharan), Laurentian University, Sudbury, Ont.; Department of Medicine (Tobe, Wald), University of Toronto, Toronto, Ont.; Department of Medicine (Pannu), University of Alberta, Edmonton, Alta. amit.garg@lhsc.on.ca.
² Departments of Medicine (Garg, McArthur, Moist, Schumann, Thiessen-Philbrook, Weir), of Epidemiology and Bio-statistics (Garg, Dubois, Moist, Weir) and of Surgery (Dubois), Western University, London, Ont.; Departments of Health Research Methods, Evidence, and Impact (Devereaux, Walsh), of Medicine (Devereaux, Walsh) and of Surgery (Iyer), McMaster University, Hamilton, Ont.; Departments of Surgery (Hill) and of Medicine (Sood, Hiremath), University of Ottawa, Ottawa, Ont.; Department of Experimental Therapeutics, Cancer Medicine and Immunology (Aggarwal), The University of Texas MD Anderson Cancer Center, Houston, Tex.; Department of Surgery (Guzman), University of Manitoba, Winnipeg, Man.; Department of Medicine (James), University of Calgary, Calgary, Alta.; Faculté de médecine (Ouellet), Université de Montréal, Montréal, Que.; Program of Applied Translational Research, Department of Medicine (Parikh), and Section of Nephrology (Parikh), Yale University School of Medicine, New Haven, Conn.; Department of Anesthesia (Sharan), Laurentian University, Sudbury, Ont.; Department of Medicine (Tobe, Wald), University of Toronto, Toronto, Ont.; Department of Medicine (Pannu), University of Alberta, Edmonton, Alta.

Abstract

Background: Curcumin, a popular herbal supplement from the plant turmeric, has prevented ischemic reperfusion and toxin-induced injury in many animal studies and a single-centre randomized human trial. We sought to test whether perioperative oral curcumin (compared with placebo) affects the inflammatory response and risk of postrepair complications after elective abdominal aortic aneurysm repair in humans.

Methods: We conducted a parallel-group, randomized, placebo-controlled trial of patients from 10 hospitals in Canada who were scheduled to undergo elective repair of an unruptured abdominal aortic aneurysm (November 2011 to November 2014). Patients in the treatment group received perioperative oral curcumin (2000-mg doses 8 times over 4 d). Patients, health care providers and local research staff were unaware of the treatment assignment. The primary outcomes were median concentrations of 4 bio markers indicating injury and inflammation (postoperative urine interleukin-18 and perioperative rise in serum creatinine, plasma N-terminal pro-B-type natriuretic peptide and plasma high-sensitivity C-reactive protein).

Results: Baseline characteristics were similar in the 2 groups (606 patients overall; median age 76 yr). More than 85% of patients in each group took more than 80% of their scheduled capsules. Neither curcumin nor placebo significantly affected any of the 4 biomarkers (p > 0.05 for all comparisons). Regarding the secondary outcomes, there was a higher risk of acute kidney injury with curcumin than with placebo (17% v. 10%, p = 0.01), but no between-group difference in the median length of hospital stay (5 v. 5 days, p > 0.9) or the risk of clinical events (9% v. 9%, p = 0.9).

Interpretation: Curcumin had no beneficial effects when used in elective abdominal aortic aneurysm repair. These findings emphasize the importance of testing turmeric and curcumin before espousing their health benefits, as is currently done in the popular media.

Trial registration: ClinicalTrials.gov, no. NCT01225094.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Administration, Oral
Aged
Aged, 80 and over
Anti-Inflammatory Agents, Non-Steroidal / administration & dosage*
Anti-Inflammatory Agents, Non-Steroidal / adverse effects
Aortic Aneurysm, Abdominal / surgery*
Biomarkers / blood
C-Reactive Protein / analysis
Creatinine / blood
Curcumin / administration & dosage*
Curcumin / adverse effects
Double-Blind Method
Elective Surgical Procedures / methods
Female
Humans
Interleukin-18 / urine
Male
Natriuretic Peptide, C-Type / blood
Perioperative Care / methods
Postoperative Complications / prevention & control*
Treatment Outcome

Substances

Anti-Inflammatory Agents, Non-Steroidal
Biomarkers
Interleukin-18
amino-terminal pro-C-type natriuretic peptide, human
Natriuretic Peptide, C-Type
C-Reactive Protein
Creatinine
Curcumin

Associated data

ClinicalTrials.gov/NCT01225094

Grants and funding

P30 DK079337/DK/NIDDK NIH HHS/United States