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Chelation therapy in cardiovascular disease: ethylenediaminetetraacetic acid, deferoxamine, and dexrazoxane
N Elihu1, S Anandasbapathy, W H Frishman
1Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
Insights
Chelation therapy for cardiovascular disease lacks sufficient evidence. More controlled studies are needed to confirm the efficacy of agents like EDTA, deferoxamine, and dexrazoxane before widespread clinical use.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Medical Research
Background:
- Chelation therapy is explored for cardiovascular disease.
- Evidence for its clinical use remains limited.
- Focus on ethylenediaminetetraacetic acid (EDTA), deferoxamine, and dexrazoxane.
Purpose of the Study:
- To review evidence for chelation therapy in cardiovascular disease.
- To assess recent placebo-controlled studies.
- To evaluate proposed mechanisms of action.
Main Methods:
- Literature review of original articles and abstracts from the past 30 years.
- Emphasis on placebo-controlled trials.
- Inclusion of studies on chelation mechanisms.
Main Results:
- EDTA has historical claims but few controlled studies and poorly understood mechanisms.
- Deferoxamine research is primarily in animal/ex vivo models.
- Dexrazoxane is approved only for specific cancer-related cardiomyopathy.
Conclusions:
- Current evidence is insufficient for broad clinical use of chelation therapy in cardiovascular disease.
- More rigorous, controlled studies are essential.
- Efficacy and safety require further investigation.
Abstract:
This review was conducted to assess whether there is sufficient evidence for the clinical use of chelation therapy in cardiovascular disease based on original articles and abstracts published in the last 30 years, with emphasis placed on the most recent placebo-controlled studies. Articles postulating the mechanisms of chelation also were included. The majority of the literature focused on three chelators in particular, ethylenediaminetetraacetic acid (EDTA), deferoxamine, and dexrazoxane (ICRF-187). Historically, much has been written on the beneficial effects of EDTA. However, there are few controlled studies, and the mechanism of action of EDTA is poorly understood. Although studies of deferoxamine are more recent, most of the research is limited to animals and ex vivo models. Recently, dexrazoxane was approved, but only for parenteral use for reducing the incidence and severity of cardiomyopathy associated with doxorubicin administration in women with metastatic breast cancer. Given these limitations, it is concluded that more controlled studies are required to determine the efficacy of chelation therapy in cardiovascular disease before it can be used broadly in the clinical setting.