A review bridging pharmacokinetics, preclinical data, and human evidence on curcuminoids in cardiovascular disease

Curcumin, the major curcuminoid of turmeric (Curcuma longa L.), has attracted sustained interest as a nutraceutical with pleiotropic anti-inflammatory, antioxidant, and vascular actions. However, extrapolating experimental in vitro findings to cardiovascular outcomes in humans is challenged by low aqueous solubility, chemical instability at intestinal pH, extensive first-pass metabolism, and substantial inter-product variability in formulation. Preclinical research supports antihypertensive and vasculoprotective effects, but many in vitro studies rely on micromolar exposures that are difficult to achieve following oral dosing. In humans, randomized trials and meta-analyses suggest modest improvements in surrogate cardiometabolic risk markers (e.g., minor alterations in lipid profiles and inflammatory biomarkers), with substantial heterogeneity across populations, doses, durations, and formulations. However, these results cannot establish turmeric-derived preparations as standard cardiovascular therapy. Evidence for clinically meaningful cardiovascular outcomes remains limited to a small number of short-term perioperative or acute coronary syndrome studies. For example, a single-center coronary artery bypass grafting trial reported fewer perioperative myocardial infarctions with high-dose curcuminoids, whereas in a larger perioperative trial nanocurcumin did not reduce postoperative atrial fibrillation. Overall, published GRADE assessments for cardiometabolic markers report low certainty. Exposure-guided, formulation-specific trials with standardized endpoints are required. In this mini review, we synthesize preclinical and human evidence on curcuminoids across key cardiovascular areas, including blood pressure and vascular function, lipid metabolism and inflammation, periprocedural myocardial injury and arrhythmias, and hemostasis. We also emphasize the importance of achieving systemic exposure, understanding metabolite biology, characterizing formulations, and using clinically relevant cardiovascular endpoints to improve the interpretability and reproducibility of future studies.