March 27, 2013
News Review From Harvard Medical School -- Chelation Therapy Shows Limited Benefit for Heart Disease
Chelation therapy showed mininal benefit in preventing heart attack, stroke or death in people who had a previous heart attack, says a study. Chelation therapy uses chemicals that combine with metals or other toxins in the body. It is used to treat lead poisoning and certain medical conditions, such as iron overload. Chelation with a chemical called ethylene diamine tetra-acetic acid (EDTA) has been promoted as a way to remove harmful metals from arteries. It is controversial. The study included 1,708 adults age 50 and older who had a previous heart attack. Half of the patients got 40 infusions of EDTA solution along with high doses of vitamin and mineral supplements into their bloodstreams; half got a placebo solution. The researchers followed the patients for an average of 4.5 years to see who had another heart problem. Twenty-six percent of people in the chelation group had heart attack, stroke or hospitalization for angina (chest pain) or heart bypass surgery compared with 30 percent of patients in the placebo group. The authors said that the results do not support the use of chelation therapy for people who have had a heart attack. The study was published March 27 in the Journal of the American Medical Association. HealthDay News wrote about it.
By Howard LeWine, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Chelation therapy uses a compound called ethylene diamine tetra-acetic acid (EDTA) to snatch charged metals from the blood and tissues. It is injected directly into the blood stream to bind tightly to the metals. They then get carried to the kidney and out of the body with urine.
For people with toxic levels of certain metals such as lead or mercury, chelation therapy provides an FDA-approved method to help with their removal from the body.
The theory behind chelation therapy as a treatment for atherosclerosis ("hardening of the arteries") revolves around calcium. In addition to providing the mortar that cements and solidifies your bones, calcium turns up in artery walls, especially in those narrowed by cholesterol-filled plaque.
EDTA infused into the bloodstream, so the thinking goes, pulls calcium out of atherosclerotic tissue. This is supposed to shrink plaque and make artery walls healthier and more flexible. Thus, risk of heart attack, stroke and other problems related to blood vessel diseases is supposedly reduced.
For decades, chelation practitioners have claimed success for the many thousands of people who spent $3,000 dollars or more of their own money for the treatment. Insurance does not cover chelation therapy for treatment.
Given the popularity of chelation therapy, the National Institutes of Health launched a $30 million study 10 years ago to hopefully answer 2 questions:
If chelation therapy is performed according to the protocol used in the study, the second question can be answered, at least short term. The therapy appears to be safe. But the median length of follow-up was only 4.5 years. Long-term safety remains unanswered.
Despite the best intentions of the researchers, the study's design and implementation have too many flaws to answer the first question. So, the results of the study are not conclusive enough to support the routine use of chelation therapy to prevent a heart attack, stroke or death in people who have had a previous heart attack.
What Changes Can I Make Now?
Chelation therapists will surely have a different take on the study results. The results indeed show some positive benefits in people receiving the chelation treatment compared to those who got only salt water infusions.
But the positive benefit was primarily fewer admissions to the hospital for angina and fewer people needing heart bypass surgery. These are considered "soft" outcomes. They are not as reliable as heart attack, stroke and death outcomes.
The EDTA solution used for chelation contained much more than EDTA. So, it's possible that one or more of the other ingredients influenced the results rather than the EDTA itself. The other ingredients included vitamins and micronutrients.
The bottom line is that we have great ways for preventing and treating atherosclerosis — the major cause of heart attacks, stroke and premature death in the United States. Here's how:
If you already have atherosclerosis, you likely should be taking aspirin daily and a statin drug (even if your cholesterol is normal).
It is very unlikely that you will get an extra benefit from chelation therapy if you practice all the proven ways to keep your heart healthy.
What Can I Expect Looking to the Future?
Chelation advocates will continue to make their claims and promote the therapy. I doubt the results of this one study will change the views of those who already believe chelation therapy works. Nor change the opinions of those who were already skeptics.
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