Complementary Alternative Cardiovascular Medicine

196 Alternative Cardiovascular Medicine
if EDTA chelation therapy was found to be effective, be considered a
target population. In contrast, those individuals who have high-risk
coronary disease suggested by significant left main coronary disease,
three-vessel disease with left ventricular dysfunction, and two-vessel
disease with proximal LAD involvement are clearly candidates for surgical
revascularization. These patients often have had coronary angiography
because of medical therapy failure or high-risk predicted by
clinical findings or stress testing. Patients who refuse angiography for
these indications may inquire about chelation therapy as a therapeutic
alternative. It is best to counsel patients against chelation therapy in this
setting, because these patients are at high risk for sudden cardiac death.
Patients with stable angina and significant left ventricular dysfunction
should avoid chelation therapy. The additional sodium and fluid
load imposed by chelation can cause left ventricular decompensation.
Additionally, a subset of these patients may benefit from revascularization.
The 1999 American Heart Association/American College of Cardiology
Guidelines for the Management of Chronic Ischemic Heart Disease
lists EDTA chelation therapy under Class III treatments, which signifies
that the authors and reviewers found only an intermediate level of scientific
evidence to support its effectiveness and where in some cases the
treatment may be harmful (46).
Peripheral Vascular Disease
Patients with acute limb ischemia should not be managed with chelation
therapy. This subgroup requires prompt angiography and definitive
endovascular or surgical intervention. In chronic peripheral arterial
occlusive disease, patients may inquire about chelation therapy as a
nonsurgical option. Symptoms range from stable intermittent claudication
to more severe symptoms of disabling claudication and rest pain.
Presently, other than smoking cessation and exercise conditioning, there
is little evidence that medical interventions improve outcomes or relieve
symptoms in peripheral vascular disease. A retrospective analysis of
more than 2800 patients receiving chelation therapy reported marked
improvement in 91% of patients with peripheral vascular disease, as
opposed to 77% of those with CAD, and only 24% with cerebral vascular
disease (10). Therefore, given the limited therapeutic choices, in a patient
who refuses revascularization or is a nonsurgical candidate, one
might consider chelation therapy as a treatment option.
Toxicity and Contraindications
When used by physicians properly trained in its use, EDTA chelation
therapy has a low morbidity rate. Renal toxicity is directly related to the
rate and dose of EDTA infused. Adherence to dosing protocols based on