Chelation Therapy

In chelation therapy, a biologically based practice, a drug is used to bind with and remove hypothesized excess or toxic amounts of a metal or mineral (eg, lead, copper, iron, calcium) from the bloodstream. In conventional medicine, chelation therapy is used to treat lead and other heavy metal poisoning (see table , a drug is used to bind with and remove hypothesized excess or toxic amounts of a metal or mineral (eg, lead, copper, iron, calcium) from the bloodstream. In conventional medicine, chelation therapy is used to treat lead and other heavy metal poisoning (see tableChelation Therapy for Heavy Metal Poisoning).

Heavy metal toxicity, usually due to environmental exposure, may be a risk factor for dementia (1), cardiovascular disease (2), and chronic kidney disease (3).

Chelation therapy with EDTA (ethylene diamine tetraacetic acid) has also been suggested as a way to remove calcium and potentially treat atherosclerosis.

A 2012 trial of chelation therapy (the Trial to Assess Chelation Therapy [TACT]) for subjects with a history of myocardial infarction found a significant benefit for chelation over placebo for a composite outcome of mortality or cardiovascular event (26.5% versus 30% for placebo), but not for individual outcomes (eg, death, cardiovascular events, stroke, hospitalizations) (4). The methodological flaws raised with the study did not end the controversy over chelation therapy. A post hoc review of the data showed a significant reduction in the composite end point in patients with diabetes and peripheral artery disease in the chelation group compared to the control group, as well as a reduction in mortality (5). A subsequent systematic review of 38 studies showed possible but unclear benefits of chelation in regard to secondary prevention of recurrent cardiac events (6). A repeat trial, TACT2, has been initiated to replicate the TACT trial in patients with diabetes and cardiovascular disease (7).

The American College of Cardiology, in its 2023 guideline for chronic coronary disease, states that EDTA chelation is not approved by the U.S. Food and Drug Administration (FDA) for prevention or treatment of cardiovascular disease and does not recommend its use outside of research settings (8).

Risks of chelation therapy include

• Hypocalcemia (which is potentially serious)

• Infusion site reaction, fever, nausea, vomiting

• Kidney damage

• Delay of more effective treatment

• Death