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Chelation therapy to prevent diabetes-associated cardiovascular events

Diaz, Denissea; Fonseca, Vivianb; Aude, Yamil W.c; Lamas, Gervasio A.a

Current Opinion in Endocrinology, Diabetes and Obesity: August 2018 - Volume 25 - Issue 4 - p 258–266
doi: 10.1097/MED.0000000000000419
DIABETES AND THE ENDOCRINE PANCREAS II: Edited by Peter A. Gottlieb

Purpose of review For over 60 years, chelation therapy with disodium ethylene diamine tetraacetic acid (EDTA, edetate) had been used for the treatment of cardiovascular disease (CVD) despite lack of scientific evidence for efficacy and safety. The Trial to Assess Chelation Therapy (TACT) was developed and received funding from the National Institutes of Health (NIH) to ascertain the safety and efficacy of chelation therapy in patients with CVD.

Recent findings This pivotal trial demonstrated an improvement in outcomes in postmyocardial infarction (MI) patients. Interestingly, it also showed a particularly large reduction in CVD events and all-cause mortality in the prespecified subgroup of patients with diabetes. The TACT results may support the concept of metal chelation to reduce metal-catalyzed oxidation reactions that promote the formation of advanced glycation end products, a precursor of diabetic atherosclerosis.

Summary In this review, we summarize the epidemiological and basic evidence linking toxic metal accumulation and diabetes-related CVD, supported by the salutary effects of chelation in TACT. If the ongoing NIH-funded TACT2, in diabetic post-MI patients, proves positive, this unique therapy will enter the armamentarium of endocrinologists and cardiologists seeking to reduce the atherosclerotic risk of their diabetic patients.

aColumbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach FL

bDepartment of Medicine, Tulane University School of Medicine, New Orleans, Louisiana

cUniversity of Texas Rio Grande Valley Doctors Hospital at Renaissance, Edinburg, Texas, USA

Correspondence to Gervasio A. Lamas, MD, Columbia University Division of Cardiology, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL 33140, USA. Tel: +1 305 674 2162; fax: +1 305 674 2169; e-mail: gervasio.lamas@msmc.com

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