Complementary Alternative Cardiovascular Medicine
Complementary Alternative Cardiovascular Medicine
Complementary Alternative Cardiovascular Medicine
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Chapter 12 / Chelation Therapy and CVD 195<br />
One study has examined the effect of EDTA chelation therapy on<br />
endothelial function (44). In an unblinded study of eight patients with<br />
CAD, endothelium-dependent forearm blood flow responses to acetylcholine<br />
were examined at baseline, after 10 sessions of chelation therapy<br />
with EDTA alone, and after 10 additional sessions with EDTA plus<br />
magnesium, thiamine, riboflavin, pyridoxine, and vitamin B 12. Interestingly,<br />
there was a trend toward improved endothelium-dependent<br />
vasodilation after EDTA alone and significantly improved flow responses<br />
after the additional course of treatment with EDTA plus B vitamins.<br />
Another somewhat larger mechanistic trial of EDTA in CAD is currently<br />
in progress. The PACT is a double-blind trial evaluating 40<br />
patients with established CAD, randomized to receive 15 infusions of<br />
either EDTA chelation solution or placebo. PACT will test the hypothesis<br />
that chelation therapy reverses endothelial dysfunction in patients with<br />
CAD by reducing oxidative stress. End-points include measurement of<br />
endothelium-dependent forearm blood flow, plasma concentrations of<br />
soluble intercellular adhesion molecule (ICAM)-1, endothelin, C-reactive<br />
protein, 8-epi-PGF 2 (a specific marker of arachidonic acid oxidation),<br />
and ascorbic acid at baseline and after the completion of the infusions.<br />
CLINICAL APPLICATIONS<br />
Up to 40% of the US population uses some form of alternative therapy.<br />
However, the majority of these individuals are not forthcoming about<br />
such treatment with their primary care physicians (45). Awareness of<br />
this dichotomy has prompted physicians to inquire directly about their<br />
patient’s use of alternative healing modalities. Increasingly, it is likely<br />
that physicians will encounter questions from their patients regarding<br />
EDTA chelation therapy for atherosclerosis. Therefore, this section is<br />
intended to provide the clinician with an understanding of the clinical<br />
applications of EDTA chelation therapy as promulgated by the American<br />
College for Advancement in <strong>Medicine</strong> (ACAM).<br />
Coronary Artery Disease<br />
Clinical observations and case studies suggest that if EDTA chelation<br />
was clinically efficacious, it would require 3–6 mo of weekly iv infusions<br />
to produce clinical benefit. Therefore it would not have a role in<br />
patients with acute coronary syndromes who should be so counseled.<br />
Patients who have spontaneous or provocable ischemia, in the face of<br />
reasonable medical therapy, are candidates for angiography and possibly<br />
coronary revascularization, not chelation therapy.<br />
Patients with chronic stable angina, which has been well controlled on<br />
medical therapy, with no evidence of left ventricular dysfunction would,