title: Chelation therapy to treat atherosclerosis, particularly in diabetes: is it time to reconsider?
abstract: BACKGROUND
  Case reports and case series have suggested a possible beneficial effect of chelation therapy in patients with atherosclerotic disease. Small randomized trials conducted in patients with angina or peripheral artery disease, however, were not sufficiently powered to provide conclusive evidence on clinical outcomes.
  
  
  METHODS
  The Trial to Assess Chelation Therapy (TACT) was the first randomized trial adequately powered to detect the effects of chelation therapy on clinical endpoints. We discuss results and future research. Expert commentary: Chelation reduced adverse cardiovascular events in a post myocardial infarction (MI) population. Patients with diabetes demonstrated even greater benefit, with a number needed to treat of 6.5 patients to prevent a cardiac event over 5 years, with a 41% relative reduction in risk of a cardiac event (p = 0.0002). These results led to the revision of the ACC/AHA guideline recommendations for chelation therapy, changing its classification from class III to class IIb. TACT2, a replicative trial, will assess the effects of chelation therapy on cardiovascular outcomes in diabetic patients with a prior myocardial infarction. We are seeking participating sites for TACT2.
authors.affiliation: a The Columbia University Division of Cardiology at Mount Sinai Medical Center , Miami Beach , FL , USA.
authors.forename: Gervasio A
authors.initials: GA
authors.lastname: Lamas
authors.affiliation: a The Columbia University Division of Cardiology at Mount Sinai Medical Center , Miami Beach , FL , USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Ergui
mesh_terms: D000787:Angina Pectoris / Q000188:drug therapy; D050197:Atherosclerosis / Q000188:drug therapy*; D002614:Chelating Agents / Q000627:therapeutic use*; D015913:Chelation Therapy / Q000379:methods*; D003920:Diabetes Mellitus / Q000188:drug therapy; D006801:Humans; D009203:Myocardial Infarction / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012306:Risk
chemical_list: D002614:Chelating Agents
keywords: Myocardial infarction; chelation; diabetes mellitus; edetate disodium; secondary prevention