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