Complementary Alternative Cardiovascular Medicine

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