Condition
Acute Coronary Syndrome (ACS)
Acute coronary syndrome covers heart attacks and unstable angina, which happen when a ruptured plaque and blood clot suddenly cut blood flow in a coronary artery. Among supplements, omega-3 fatty acids have the strongest evidence, followed by coenzyme Q10. A small curcumin trial of 63 people found HDL cholesterol improved, but evidence for creatinol O-phosphate is limited and mostly animal or lab work.
Sources: PMID 7021841
- Supplements studied
- 2
- Medicines and peptides
- 1
- Graded outcomes
- 5
- Trials
- 1
- People studied
- 63
Evidence by supplement
- Strong
- Moderate
- Limited
- Very limited
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Myocardial Ischemia Protection (IV Administration) A double-blind clinical trial found IV COP improved outcomes in patients with inadequate coronary circulation. Animal studies in rats and mice showed COP protected against isoprenaline-induced cardiac enzyme elevation and CaCl2-induced ventricular fibrillation. An in vitro NMR study in perfused Xenopus heart confirmed effects on cardiac energy metabolism. All evidence is from IV or direct perfusion, not oral dosing. | Improves (the measure goes up) | Moderate effect | 10 studies | 80 people | ||
Studies that measured myocardial ischemia protection (iv administration)
| ||||||
Prescription medicines and peptides studied, for context
Eptifibatide (Integrilin)
- Death/MI/Refractory Ischemia: improves
- Major Bleeding: worsens
- Thrombocytopenia: worsens
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Death/MI/Refractory Ischemia PURSUIT (n=10,948): Composite endpoint 14.2% vs 15.7% placebo at 30 days (P=0.04). 1.5% absolute risk reduction. Benefit apparent by 96 hours. NNT=67 to prevent one event. | Improves (the measure goes down) | Small effect | 21 studies | |||
| Major Bleeding SAFETY CONCERN: ESPRIT: Major bleeding 1.3% vs 0.4% placebo (P=0.027). PURSUIT: 2.1% vs 1.3%. Most bleeding at femoral access sites, mild. No increase in hemorrhagic stroke. ISMP high-risk medication. | Worsens (the measure goes up) | Small effect | 20 studies | |||
| Thrombocytopenia SAFETY CONCERN: Significant thrombocytopenia (<20,000/μL) in 0.2% of patients in ESPRIT. Platelet monitoring recommended. Generally reversible upon discontinuation. | Worsens (the measure goes down) | Small effect | 21 studies |
Key findings
- Myocardial Ischemia Protection (IV Administration)Improves (the measure goes up)
- High-density lipoprotein (HDL)Improves (the measure goes up)
Safety notes in the studies
- 1.5% absolute risk reduction.
- ISMP high-risk medication.
The Post-Acute Coronary Syndrome Recovery Support protocol
2 primary supplements · 6 supporting supplements
- Omega-3 Fatty Acids2–4 g EPA+DHA daily (prescription-strength for triglyceride lowering)
- Coenzyme Q10100–300 mg daily
Shop the evidence-backed picks
Support alongside medical care. These supplements are not a treatment for Acute Coronary Syndrome (ACS). If you are being treated for it, talk to your clinician before adding one: supplements can interact with medicines.
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Studies cited
100 studies from PubMed
- Safety and efficacy of adjunctive tirofiban and eptifibatide in acute ischemic stroke: A systematic review and meta-analysis.
- Effect of curcumin on inflammatory markers and disease activity in patients with rheumatoid arthritis: A meta-analysis.
- Eptifibatide as an adjuvant therapy to thrombolysis versus thrombolysis alone in stroke management: a systematic review and meta-analysis of randomized controlled trials.
- The Effect of Antioxidant Polyphenol Supplementation on Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis.
- The Effectiveness of Curcumin, Resveratrol, and Silymarin on MASLD: A Systematic Review and Meta-Analysis.
- A Double-Blinded Randomized Controlled Trial Comparing Eptifibatide Bolus Only Versus Bolus Plus Infusion In Patients Undergoing Primary Percutaneous Coronary Intervention For ST-Elevation Myocardial Infarction.
- Intracoronary eptifibatide with vasodilators to prevent no-reflow in diabetic STEMI with high thrombus burden. A randomized trial.
- Efficacy outcomes and safety measures of intravenous tirofiban or eptifibatide for patients with acute ischemic stroke: a systematic review and meta-analysis of prospective studies.
- Efficacy and Safety of Abbreviated Eptifibatide Treatment in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.
- Clinical Evaluation of the Tolerability, Pharmacokinetics, and Inhibition of Platelet Aggregation of Eptifibatide in Healthy Chinese Subjects.
- Antiplatelet agents'-ticagrelol and eptifibatide-safety in experimental colitis in mice.
- Thrombocytopenia and Thromboses in Myocardial Infarction Associated with Eptifibatide-Dependent Activating Antiplatelet Antibodies.
- Co-administration of iloprost and eptifibatide in septic shock (CO-ILEPSS)-a randomised, controlled, double-blind investigator-initiated trial investigating safety and efficacy.
- Effects of Crushed Ticagrelor Versus Eptifibatide Bolus Plus Clopidogrel in Troponin-Negative Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: A Randomized Clinical Trial.
- Curcumin alleviates postprandial glycaemic response in healthy subjects: A cross-over, randomized controlled study
- Substantial Variability Across Individuals in the Vascular and Nutrigenomic Response to an Acute Intake of Curcumin: A Randomized Controlled Trial
- Curcumin supplementation improves vascular endothelial function in healthy middle-aged and older adults by increasing nitric oxide bioavailability and reducing oxidative stress
- Efficacy and safety of eptifibatide versus tirofiban in acute coronary syndrome patients: A systematic review and meta-analysis.
- Novel Form of Curcumin Improves Endothelial Function in Young, Healthy Individuals: A Double-Blind Placebo Controlled Study
- Is eptifibatide a safe and effective rescue therapy in thromboembolic events complicating cerebral aneurysm coil embolization? Single-center experience in 42 cases and review of the literature.
- Bleeding risk and safety profile related to the use of eptifibatide: a current review
- Effect of different curcuminoid supplement dosages on total in vivo antioxidant capacity and cholesterol levels of healthy human subjects
- The kinetics of integrilin limited by obesity: a multicenter randomized pharmacokinetic and pharmacodynamic clinical trial.
- Effects of Curcuma longa (turmeric) on postprandial plasma glucose and insulin in healthy subjects
- Combined inhibitory effects of soy isoflavones and curcumin on the production of prostate-specific antigen
- Prolonged infusion of eptifibatide as bridge therapy between bare-metal stent insertion and cardiovascular surgery: case report and review of the literature.
- Comparison by meta-analysis of eptifibatide and tirofiban to abciximab in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention.
- Safety of eptifibatide for subcortical stroke progression.
- Primary percutaneous coronary angioplasty with and without eptifibatide in ST-segment elevation myocardial infarction: a safety and efficacy study of integrilin-facilitated versus primary percutaneous coronary intervention in ST-segment elevation myocardial infarction (ASSIST).
- Effect of NCB-02, atorvastatin and placebo on endothelial function, oxidative stress and inflammatory markers in patients with type 2 diabetes mellitus: a randomized, parallel-group, placebo-controlled, 8-week study
- Eptifibatide
- A review of clinical trials with eptifibatide in cardiology.
- Chili, but not turmeric, inhibits iron absorption in young women from an iron-fortified composite meal
- Early initiation of eptifibatide in the emergency department before primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: results of the Time to Integrilin Therapy in Acute Myocardial Infarction (TITAN)-TIMI 34 trial.
- Early eptifibatide improves TIMI 3 patency before primary percutaneous coronary intervention for acute ST elevation myocardial infarction: results of the randomized integrilin in acute myocardial infarction (INTAMI) pilot trial.
- Administration of intracoronary eptifibatide during ST-elevation myocardial infarction.
- Eptifibatide: a review of its use in patients with acute coronary syndromes and/or undergoing percutaneous coronary intervention.
- Association between platelet receptor occupancy after eptifibatide (integrilin) therapy and patency, myocardial perfusion, and ST-segment resolution among patients with ST-segment-elevation myocardial infarction: an INTEGRITI (Integrilin and Tenecteplase in Acute Myocardial Infarction) substudy.
- Combination reperfusion therapy with eptifibatide and reduced-dose tenecteplase for ST-elevation myocardial infarction: results of the integrilin and tenecteplase in acute myocardial infarction (INTEGRITI) Phase II Angiographic Trial.
- Safety of concomitant therapy with eptifibatide and enoxaparin in patients undergoing percutaneous coronary intervention: results of the Coronary Revascularization Using Integrilin and Single bolus Enoxaparin Study.
- Eptifibatide-induced acute profound thrombocytopenia presenting as refractory hypotension.
- Eptifibatide: a pharmacoeconomic review of its use in percutaneous coronary intervention and acute coronary syndromes.
- Eptifibatide and low-dose tissue plasminogen activator in acute myocardial infarction: the integrilin and low-dose thrombolysis in acute myocardial infarction (INTRO AMI) trial.
- Platelet glycoprotein IIb/IIIa receptor blockade with integrilin (eptifibatide) for early postinfarction angina in a patient with coronary arterial ectasia.
- Eptifibatide in percutaneous coronary intervention. A review.
- Platelet glycoprotein IIb/IIIa integrin blockade with eptifibatide in coronary stent intervention: the ESPRIT trial: a randomized controlled trial
- Attenuation of rebound ischemia after discontinuation of heparin therapy by glycoprotein IIb/IIIa inhibition with eptifibatide in patients with acute coronary syndromes: observations from the platelet IIb/IIIa in unstable angina: receptor suppression using integrilin therapy (PURSUIT) trial.
- Meta-analysis of effectiveness and safety of abciximab versus eptifibatide or tirofiban in percutaneous coronary intervention.
- Novel dosing regimen of eptifibatide in planned coronary stent implantation (ESPRIT): a randomised, placebo-controlled trial
- Early percutaneous coronary intervention, platelet inhibition with eptifibatide, and clinical outcomes in patients with acute coronary syndromes. PURSUIT Investigators
- Recurrent ischemia during continuous 12-lead ECG-ischemia monitoring in patients with acute coronary syndromes treated with eptifibatide: relation with death and myocardial infarction. PURSUIT ECG-Ischemia Monitoring Substudy Investigators. Platelet glycoprotein IIb/IIIa in Unstable angina: Receptor Suppression Using Integrilin Therapy.
- Eptifibatide: a review of its use in patients with acute coronary syndromes and/or undergoing percutaneous coronary intervention
- Clinical outcomes after detection of elevated cardiac enzymes in patients undergoing percutaneous intervention. IMPACT-II Investigators. Integrilin (eptifibatide) to Minimize Platelet Aggregation and Coronary Thrombosis-II.
- Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes
- Modifiable risk factors for vascular access site complications in the IMPACT II Trial of angioplasty with versus without eptifibatide
- Randomised placebo-controlled trial of effect of eptifibatide on complications of percutaneous coronary intervention: IMPACT-II
- Design and methodology of the PURSUIT trial: evaluating eptifibatide for acute ischemic coronary syndromes
- Combined accelerated tissue-plasminogen activator and platelet glycoprotein IIb/IIIa integrin receptor blockade with Integrilin in acute myocardial infarction. Results of a randomized, placebo-controlled, dose-ranging trial. IMPACT-AMI Investigators.
- Primary and secondary safety endpoints from IMPACT II. Integrilin to Minimize Platelet Aggregation and Coronary Thrombosis.
- Impact of eptifibatide on early ischemic events in acute ischemic coronary syndromes: a review of the IMPACT II trial. Integrilin to Minimize Platelet Aggregation and Coronary Thrombosis.
- A 31P NMR spectroscopy study of Xenopus laevis heart perfused in vitro with creatinol-O-phosphate, phosphocreatine, adenosine triphosphate, fructose diphosphate and ouabain.
- Double-blind evaluation of creatinol O-phosphate in chronic congestive heart insufficiency
- Antiarrhythmic effects of creatinol O-phosphate
- Creatinol O-phosphate in acute myocardial infarction
- Antiarrhythmic effectiveness of creatinol O-phosphate in man.
- Pharmacological and toxicological properties of creatinol O-phosphate. A review.
- Creatinol O-phosphate therapy in patients with inadequate coronary circulation. Double blind clinical trial.
- Activity of creatinol O-phosphate on persistent ventricular premature beats in ischemic heart disease. Double blind clinical trial.
- Acute clinical tolerance of creatinol O-phosphate.
- Protective action of creatinol O-phosphate against serum CPK activity enhanced by isoprenaline in the rat.
- Protective effect of creatinol O-phosphate (COP) on ventricular fibrillation and death induced by intravenous CaCl2 in mice.
- Protective effect of creatinol O-phosphate (COP) on some experimental arrhythmias in vitro and in vivo.
- Effects of creatinol O-phosphate on serum enzymes in acute myocardial infarction.
- Preliminary report on electrophysiological effectiveness of creatinol O-phosphate (COP) in human subjects.
- Effects of creatinol-O-phosphate (COP) on haemodynamics and cardiac metabolism in conscious and anaesthetized dogs.
- Efficacy of Curcuma longa in relieving pain symptoms of knee osteoarthritis patients: a systematic review and meta-analysis of clinical trials.
- Curcuma longa extract reduces inflammatory and oxidative stress biomarkers in osteoarthritis of knee: a four-month, double-blind, randomized, placebo-controlled trial
- Efficacy and safety of curcumin and its combination with boswellic acid in osteoarthritis: a comparative, randomized, double-blind, placebo-controlled study
- Short-term effects of highly-bioavailable curcumin for treating knee osteoarthritis: a randomized, double-blind, placebo-controlled prospective study
- Safety and efficacy of curcumin versus diclofenac in knee osteoarthritis: a randomized open-label parallel-arm study
- Curcuminoid treatment for knee osteoarthritis: a randomized double-blind placebo-controlled trial
- Safety and efficacy of Curcuma longa extract in the treatment of painful knee osteoarthritis: a randomized placebo-controlled trial
- Efficacy and safety of Meriva®, a curcumin-phosphatidylcholine complex, during extended administration in osteoarthritis patients
- Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: a multicenter study
- Product-evaluation registry of Meriva®, a curcumin-phosphatidylcholine complex, for the complementary management of osteoarthritis
- The efficacy of Curcuma Longa L. extract as an adjuvant therapy in primary knee osteoarthritis: a randomized control trial
- A Randomized, Double Blind, Placebo Controlled, Parallel-Group Study to Evaluate the Safety and Efficacy of Curene® versus Placebo in Reducing Symptoms of Knee OA
- Efficacy and safety of Curcuma domestica extracts in patients with knee osteoarthritis
- Efficacy and safety of curcumin therapy for knee osteoarthritis: A Bayesian network meta-analysis.
- Effect of turmeric products on knee osteoarthritis: a systematic review and network meta-analysis.
- Effects of curcumin on serum inflammatory biomarkers in patients with knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials.
- Curcumin Lowers Serum Lipids and Uric Acid in Subjects With Nonalcoholic Fatty Liver Disease: A Randomized Controlled Trial
- The effects of curcumin supplementation on liver enzymes, lipid profile, glucose homeostasis, and hepatic steatosis and fibrosis in patients with non-alcoholic fatty liver disease
- Treatment of Non-alcoholic Fatty Liver Disease with Curcumin: A Randomized Placebo-controlled Trial
- Nano-curcumin improves glucose indices, lipids, inflammation, and Nesfatin in overweight and obese patients with non-alcoholic fatty liver disease (NAFLD): a double-blind randomized placebo-controlled clinical trial
- Curcumin as adjuvant treatment in patients with non-alcoholic fatty liver (NAFLD) disease: A systematic review and meta-analysis
- Turmeric Supplementation Improves Serum Glucose Indices and Leptin Levels in Patients with Nonalcoholic Fatty Liver Diseases
- Does Turmeric/curcumin Supplementation Change Anthropometric Indices in Patients with Non-alcoholic Fatty Liver Disease? A Systematic Review and Meta-analysis of Randomized Controlled Trials.
- Highly bioavailable micellar curcuminoids accumulate in blood, are safe and do not reduce blood lipids and inflammation markers in moderately hyperlipidemic individuals
- Efficacy of Turmeric as Adjuvant Therapy in Type 2 Diabetic Patients