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Chelation therapy: what it is, when it is used

By Cristiano Antonino On Jun 1, 2022

In chelation therapy, a biologically based therapy, a drug is used to bind and remove a hypothetical excess or toxic amount of a metal or mineral (e.g., lead, copper, iron, calcium) from the blood stream

In conventional medicine, chelation therapy is a widely accepted way of treating lead poisoning and other heavy metals

Heavy metal toxicity, usually due to environmental exposure, can be a risk factor for dementia (1), cardiovascular disease, and chronic kidney disease.

Chelation therapy with ethylenediaminetetraacetic acid has been proposed as a method to remove calcium and thus treat atherosclerosis.

However, despite > 50 years of study, researchers have not identified any mechanism to explain how chelation therapy could treat atherosclerosis or prevent heart attacks or strokes.

In 2012, a large randomised placebo-controlled trial of chelation (called Trial to Assess Chelation Therapy [TACT]) found a significant benefit for chelation over placebo for composite (outcome) outcomes (26.5% vs 30% for placebo), but not for individual outcomes (e.g., death, cardiovascular events, stroke, hospitalisations).

This study had methodological flaws and did not end the controversy over chelation therapy; however, a retrospective review of the data showed a significant reduction in the composite endpoint in patients with diabetes and peripheral artery disease in the chelation group compared to the control group, as well as a reduction in mortality.

A subsequent systematic review of 38 studies showed the possible but unclear benefits of chelation in relation to secondary prevention of recurrent cardiac events.

Risks of chelation therapy include

Hypocalcaemia (which is potentially serious)
Infusion site reaction, fever, nausea, vomiting
Renal damage
Delay in more effective treatment
Death

References:

Killin LO, Starr JM, Shiue IJ, et al: Environmental risk factors for dementia: a systematic review. BMC Geriatr 16(1):175, 2016. doi: 10.1186/s12877-016-0342-y
Chowdhury R, Ramond A, O’Keeffe LM, et al: Environmental toxic metal contaminants and risk of cardiovascular disease: systematic review and meta-analysis. BMJ 362:k3310, 2018. doi: 10.1136/bmj.k3310
Farkhondeh T, Naseri K, Esform A, et al: Drinking water heavy metal toxicity and chronic kidney diseases: a systematic review. Rev Environ Health. 2020 Nov 2:/j/reveh.ahead-of-print/reveh-2020-0110/reveh-2020-0110.xml. doi: 10.1515/reveh-2020-0110
Lamas GA, Goertz C, Boineau R, et al: Effect of disodium EDTA chelation regimen on cardiovascular events in patients with previous myocardial infarction: the TACT randomized trial. JAMA. 309(12):1241–50, 2013. doi: 10.1001/jama.2013.2107
Ujueta F, Arenas IA, Escolar E, et al: The effect of EDTA-based chelation on patients with diabetes and peripheral artery disease in the Trial to Assess Chelation Therapy (TACT). J Diabetes Complications 33(7):490-494, 2019. doi: 10.1016/j.jdiacomp.2019.04.005
Ibad A, Khalid R, Thompson PD, et al: Chelation therapy in the treatment of cardiovascular diseases. J Clin Lipidol 10(1):58-62, 2016. doi: 10.1016/j.jacl.2015.09.005