Clinical Investigations: Acute Ischemic Heart Disease
Chelation therapy for coronary heart disease: An overview of all clinical investigations

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Abstract

Background Chelation therapy is popular in the United States. The question of whether it does more good than harm remains controversial. Aim The aim of this systematic review was to summarize all the clinical evidence for or against the effectiveness and efficacy of chelation therapy for coronary heart disease. Methods A thorough search strategy was implemented to retrieve all clinical investigations regardless of whether they were controlled or uncontrolled. Results The most striking finding is the almost total lack of convincing evidence for efficacy. Numerous case reports and case series were found. The majority of these publications seem to indicate that chelation therapy is effective. Only 2 controlled clinical trials were located. They provide no evidence that chelation therapy is efficacious beyond a powerful placebo effect. Conclusion: Given the potential of chelation therapy to cause severe adverse effects, this treatment should now be considered obsolete. (Am Heart J 2000;140:139-41.)

Section snippets

Methods

Four independent, computerized literature searches were performed, all from earliest possible available data to the end of 1998 (Medline, Embase, Cochrane Library, and CISCOM [a database specialized in complementary/alternative medicine]). The aim was to identify all clinical investigations of chelation therapy for cardiovascular disease. The key words used were chelation, EDTA, ethylenediamine tetraacetic acid, edeteate, edeteate sodium, edetic acid, vascular disease, and controlled clinical

Results

Twenty-two studies8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29 without control groups were located (Table I). The majority of these studies were published in the 1960s and report subjective symptomatic improvements in most patients. The 2 case reports that included objective angiographic results25, 26 showed no evidence of benefit.

Only 2 controlled clinical trials were located.17, 30 Kitchell et al17 conducted a placebo-controlled, double-blind, crossover

Discussion

These reports collectively provide no reliable evidence to suggest that chelation therapy is of benefit in CHD. Most of the uncontrolled data imply that chelation has positive effects. These reports are consistent with a powerful placebo effect of chelation treatment. The power of the placebo responses in CHD is perhaps best highlighted by the fact that sham surgery has been shown to yield symptomatic benefit in the vast majority of CHD patients.31 When angiographic verification is sought in

References (37)

  • LT Chappell et al.

    The correlation between EDTA chelation therapy and improvement in cardiovascular function: a meta-analysis

    J Advancement Med

    (1993)
  • NE Clarke et al.

    The “in vivo” dissolution of metastatic calcium: an approach to atherosclerosis

    Am J Med Sci

    (1955)
  • NE Clarke et al.

    Treatment of angina pectoris with disodium EDTA

    Am J Med Sci

    (1956)
  • AJ Boyle et al.

    Studies in human and induced atherosclerosis employing EDTA

    Bull Schw Akad Wiss

    (1957)
  • LE. Meltzer

    Chelation therapy

  • NE Clarke et al.

    Treatment of occlusive vascular disease with disodium EDTA

    Am J Med Sci

    (1960)
  • AJ Boyle et al.

    Chelation therapy in circulatory and sclerosing diseases

    Fed Proc

    (1961)
  • LE Meltzer et al.

    The long-term use, side-effects, and toxicity of disodium EDTA

    Am J Med Sci

    (1961)
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    Reprint requests: E. Ernst, MD, Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, 25 Victoria Park Rd, Exeter EX2 4NT, United Kingdom. E-mail: [email protected]

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