CLINICAL STUDY: ATHEROSCLEROSIS
Effect of chelation therapy on endothelial function in patients with coronary artery disease: PATCH substudy
Todd J. Anderson, MD, FRCP(C)*,*,
Jaroslav Hubacek, MD, MSc*,
D. George Wyse, MD, PhD, FRCP(C)* and
Merril L. Knudtson, MD, FRCP(C)*
* Faculty of Medicine, University of Calgary and Calgary Health Region, Calgary, Canada
Manuscript received June 7, 2002;
revised manuscript received October 2, 2002,
accepted October 17, 2002.
* Reprint requests and correspondence: Dr. Todd J. Anderson, 1403 29th Street NW, Calgary, Alberta T2N 2T9, Canada.
todd.anderson{at}calgaryhealthregion.ca
OBJECTIVES: The purpose of this study was to evaluate the effect of chelation therapy with ethylenediamine tetraacetic acid (EDTA) on endothelium-dependent vasomotor responses in patients with documented coronary artery disease (CAD).
BACKGROUND: Oxidative stress plays an important role in the dysfunction of endothelium and development of atherosclerosis. Modification of cardiac risk factors and employment of antioxidants have been shown to improve endothelial function. Ethylenediamine tetraacetic acid chelation therapy is considered to be a complementary therapy for patients with CAD and is proposed to have antioxidant properties.
METHODS: A total of 47 patients enrolled in the Program to Assess Alternative Treatment Strategies to Achieve Cardiac Health (PATCH) participated in this substudy and had complete data. High-resolution ultrasound was used to assess endothelium-dependent brachial artery flow-mediated vasodilation (FMD) in patients with CAD in a randomized, double-blind, and placebo-controlled fashion. Patients were randomized to chelation therapy or placebo. The primary end point was the absolute difference in FMD after the first and 33rd treatments (6 months) of study groups compared with their baselines.
RESULTS: At the baseline, the study population had mild impairment of FMD (7.2 ± 3.4%). The first chelation treatment did not change FMD as compared with placebo (chelation 6.5 ± 3.5% vs. placebo 7.4 ± 2.9%; p value = 0.371). The brachial artery studies at six months did not demonstrate significant differences in FMD between study groups (placebo 7.3 ± 3.4% vs. chelation 7.3 ± 3.2%; p value = 0.961).
CONCLUSIONS: Our results suggest that EDTA chelation therapy in combination with vitamins and minerals does not provide additional benefits on abnormal vasomotor responses in patients with CAD optimally treated with proven therapies for atherosclerotic risk factors.
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Abbreviations and Acronyms
| | ACE | | angiotensin-converting enzyme | | CAD | | coronary artery disease | | EDTA | | ethylenediamine tetraacetic acid | | eNOS | | endothelial nitric oxide synthase | | FMD | | flow-mediated vasodilation | | NO | | nitric oxide | | NTG | | nitroglycerin | | PATCH | | Program to Assess Alternative Treatment Strategies to Achieve Cardiac Health |
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