Chelation Therapy for Peripheral Arterial Occlusive Disease
1997; Lippincott Williams & Wilkins; Volume: 96; Issue: 3 Linguagem: Inglês
10.1161/01.cir.96.3.1031
ISSN1524-4539
Autores Tópico(s)Systemic Sclerosis and Related Diseases
ResumoHomeCirculationVol. 96, No. 3Chelation Therapy for Peripheral Arterial Occlusive Disease Free AccessResearch ArticleDownload EPUBAboutView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticleDownload EPUBChelation Therapy for Peripheral Arterial Occlusive Disease A Systematic Review E. Ernst E. ErnstE. Ernst From the Department of Complementary Medicine, Postgraduate Medical School, Exeter, UK. Originally published5 Aug 1997https://doi.org/10.1161/01.CIR.96.3.1031Circulation. 1997;96:1031–1033Chelation therapy is viewed, promoted, and practiced as a form of complementary/alternative medicine (see References 1 and 212 ). It uses repeated intravenous administration of EDTA, usually in combination with vitamins, trace elements, and iron supplements as a treatment for a variety of diseases.345 Oral chelation therapy also has been advocated (see Reference 66 ) but will be excluded from this review. Among others, chelation therapy is claimed to be effective in reversing the arteriosclerotic disease process,78 in particular peripheral arterial occlusive disease (PAOD). Proponents claim that it can be an alternative for amputation in severe cases.8 This goes back to an observation made in the 1950s, when it was noted that patients undergoing EDTA therapy for lead poisoning felt a relief of angina pectoris after this therapy.9 While various authors9101112131415 have subsequently reported promising results in uncontrolled studies, others have been unable to confirm these in similarly designed trials.1617 The debate of whether or not it is a useful form of therapy for PAOD therefore continues.1819202122232425Meanwhile, numerous clinics have been set up in Europe, the United States, and elsewhere using and promoting chelation therapy for PAOD. In the light of recent trial data, it is therefore timely to systematically review the evidence from randomized, placebo-controlled, double-blind trials and ask whether chelation therapy for PAOD is safe and effective.MethodsComputerized literature searches were performed (Medline 1966 to 1996; CISCOM 1996, a database specialized in complementary/alternative medicine) to identify all studies on the subjects. Publications thus found were screened for further relevant articles in their bibliographies. In addition, leading experts and national societies (n=6) were contacted and asked for further material. Studies were admitted into the present review if they related to randomized, placebo-controlled, double-blind clinical trials of intravenous chelation therapy for PAOD.ResultsFour such publications referring to three trials were found (see Table). These will be discussed below. All studies relate to patients suffering from intermittent claudication.Olszewer and colleagues26 conducted a small trial (n=10) in male patients, most of them recent ex-smokers. They received either intravenous injections of Na2 EDTA (10 mL) or "distilled water" (more likely saline). Both groups were also given vitamin C (2 g), vitamin B complex (2 mL), vitamin B6 (300 mg), heparin (500 IU), and magnesium sulfate (1 g). Twenty treatment sessions were carried out. During the first 10 treatments, the study was conducted double blind; subsequently it was single (patient) blind. After 10 treatments, the patients in the EDTA group had substantially increased their walking distance, while in the placebo group the improvements were numerically less. Similar results could be demonstrated in ankle/arm blood pressure. The authors are unclear as to the method of data analysis and several other methodological features, rendering evaluation of this trial difficult. They state that there were no intergroup differences at the end of the double-blind phase. Notwithstanding, the authors claim, presumably on the basis of intra-group change in the experimental group (which is an inadequate way of analyzing parallel group studies), that "EDTA had a significant impact in causing the improvement."Guldager and coworkers27 published a double-blind, placebo-controlled trial on the topic. They randomized 153 patients to receive either EDTA (3 g Na2-EDTA per treatment with vitamins and trace minerals) or placebo. Twenty treatments were carried out in each group. At the end of the 5- to 9-week treatment phase, there were no significant inter-group differences in any of the outcome parameters (arteriogram, O2 pressure, subjective patient judgment). After 6 months of follow-up, this situation was unchanged.Sloth-Nielsen et al28 published further results from the same trial. A subgroup (n=30) of patients had also been investigated with transcutaneous O2 measurements and angiograms before and after the series of treatments. The results show no advantage for patients in the experimental group compared with the control group. On the contrary, in this subpopulation there was a (nonsignificant) trend for the maximal walking distance and the peripheral arterial pressure to increase to a greater extent in the placebo group than in the EDTA group.Recently, another placebo-controlled, double-blind study was published.29 Thirty-two patients were randomized. Fifteen received 20 infusions at 500 mL, each containing 3 g disodium EDTA plus 0.76 g magnesium chloride and 0.84 g sodium bicarbonate in normal saline. Seventeen patients were treated with 20 indistinguishable saline infusions. The treatment period lasted 10 weeks, and all patients were subsequently observed for 3 months. The predefined, primary end points were subjective and objective walking distances and ankle/arm pressure. In addition, a wide range of secondary outcome measures (including subjective judgment) were included. None of these parameters showed changes to suggest that chelation therapy was superior to placebo. Subjective variables such as quality of life also did not indicate superiority of one treatment over the other. Finally, the proportion of patients who did improve did not differ in the two groups (60% versus 59%), and patients were unable to tell, at the conclusion of their series of infusions, which treatment (active or placebo) they had received.CommentsChelation therapy with EDTA binds ions in the blood. It is therefore highly effective in heavy metal poisoning,30 for which it is the treatment of choice. In complementary/alternative medicine, it is used with a view to extracting calcium out of arteriosclerotic plaques.26 It is claimed that through the chelating mechanism, it deblocks arteriosclerotic arteries and thus represents a causal treatment for arteriosclerosis, "accelerating regression" of plaques.113132 This rationale is (at best) based on an outdated understanding of artherogenesis. There is reason to believe33 that proponents of chelation therapy adhere to pathophysiological models of arteriosclerosis, which are in overt discordance with our present knowledge.An outdated (or even false) rationale does not necessarily preclude clinical effectiveness. So, does it work? The above four trials are heterogeneous in several respects. One trial26 is of poor quality in that it lacks methodological data essential for interpretation. The other studies272829 are of outstanding methodological rigor. Thus their results are convincing and definitive. Their cumulative results clearly and conclusively show that in PAOD, chelation therapy does not ameliorate symptoms (eg, prolong walking distance), nor does it change objective signs of the disease (eg, ankle/arm pressure, angiogram) or the subjective well-being (eg, activities of daily life, quality of life) to a greater extent than placebo treatment. This is true both in the short term and the long term. Thus, it is fair to say that EDTA is not an effective treatment for this condition.Notwithstanding these indisputable facts, advocates of chelation therapy remain convinced that it works—so much so that comparative studies are conducted in which one dose of EDTA is compared with another and, on the basis of improvements in both groups, it is concluded that "EDTA is effective in treating peripheral vascular disease."34 The belief in chelation therapy is also based on a "meta-analysis" of 40 studies including 22 765 patients.35 This analysis refers almost exclusively to uncontrolled trials and is therefore far from compelling.The above data also demonstrate that chelation therapy is associated with a large, positive placebo response. In one study,29 59% of patients in the placebo group showed a prolongation of walking distance. Thus, one might argue that chelation therapy may not be superior to placebo, yet it could still be very useful through powerful nonspecific effects. But is it? Through its chelating action, EDTA treatment is associated with severe, life-threatening adverse effects.2735 In one trial, 6 patients of the experimental group showed clinical signs of (potentially lethal) hypocalcemia.28 Furthermore, there have been reports about severe kidney damage after chelation therapy.1617 Nonetheless, proponents of chelation therapy maintain that problems occur only when EDTA is overdosed in patients with preexisting kidney pathology.36 Finally, harm also can be done by the needless expense, and it is therefore noteworthy that chelation therapy is usually done repeatedly over prolonged periods of time and against considerable fees.ConclusionsChelation therapy for PAOD is not superior to placebo. It is associated with considerable risks and costs. It should now be considered obsolete. Table 1. Randomized, Placebo-Controlled, Double-Blind Trials of Chelation Therapy for PAODFirst Author (Year)nDescription of SampleInterventionTreatment SchedulePrimary Outcome MeasureFollow-upResultsOlszewer (1990)10 (uni)Men with intermittent claudication "from diabetes or arteriosclerosis"10 mL with 1.5 g Na2 EDTA vs "distilled water" plus vitamins and 500 IU heparin10 infusions (no further details)Not defined (walking distances and ankle/arm indexes were determined)Not definedNo intergroup differencesSloth-Nielsen (1991)30 (unit)Stable intermittent claudication PFWD=50–200 m, minimum length of history=12 mo1000 mL IV infusions of 3 g Na2 EDTA and 8.4 NaCl vs isotonic saline plus mineral supplements20 infusions over 5–9 wkTranscutaneous O2 tension, angiogram6 moNo intergroup differencesGuldager (1992)153 (multi)Stable intermittent claudication, PFWD=50–200 m, minimum length of history=12 mo1000 mL IV infusions of 3 g Na2 EDTA and 8.4 NaCl vs isotonic saline plus mineral supplements20 infusions over 5–9 wkWalking distances, ankle/arm blood pressure6 moNo intergroup differencesvan Rij (1994)32 (uni)Stable intermittent claudication, PAOD confirmed by arteriogram, nondiabetic500 mL IV infusions of 3 g Na2 EDTA, 0.76 g magnesium chloride, 0.84 g Na2 bicarbonate in saline vs isotonic saline plus mineral supplements20 infusions, 2 per wk for 20 wkWalking distances ankle/arm blood pressure index3 moNo intergroup differencesPAOD indicates peripheral arterial occlusive disease; uni, unicenter trial; multi, multicenter trial; and PFWD, pain-free walking distance.FootnotesCorrespondence to E. Ernst, MD, PhD, Department of Complementary Medicine, Postgraduate Medical School, 25 Victoria Park Rd, Exeter EX2 4NT, UK. E-mail [email protected] References 1 Brecher H, Brecher A. Forty something forever: a consumer's guide to chelation therapy and other heart savers. Health Conscious.1994; 15:35–38.Google Scholar2 Dingle DL. Chelation for osteoporosis. Dig Chiropractic Econ.1986; 29:74.Google Scholar3 Blumer W, Cranton EM. Ninety percent reduction in cancer mortality after chelation therapy with EDTA. J Adv Med.1989; 2:183–187.Google Scholar4 Olszewer E, Carter JC. EDTA chelation therapy in chronic degenerative disease. Med Hypotheses.1988; 27:41–49.CrossrefMedlineGoogle Scholar5 Olszewer E, Carter JP. EDTA chelation therapy: a retrospective study of 2,870 patients. J Adv Med.1989; 2:197–211.Google Scholar6 Laquasto MJ. How is their circulation? Oral chelation. Am Chiropractor. 1985;248.Google Scholar7 Godfrey ME. EDTA chelation as a treatment of arteriosclerosis. N Z Med J.1990; 103:162–163.MedlineGoogle Scholar8 Casadorph RH, Farr CH. EDTA chelation therapy. III: treatment of peripheral arterial occlusion, an alternative to amputation. J Hol Med.1983; 5:3–15.Google Scholar9 Clarke NE, Clarke CN, Mosher RE. The 'in-vivo' dissolution of metastatic calcium: an approach to atherosclerosis. Am J Med Sci.1955; 229:142–149.CrossrefMedlineGoogle Scholar10 Boyle AJ, Jasper JJ, McCormic H. Clinic and therapy: studies in human and induced atherosclerosis employing ethylene diamine tetraacetic acid. Bull Schweiz Akad Med Wiss.1957; 13:408–425.MedlineGoogle Scholar11 Casdorph HR. EDTA chelation therapy: efficacy in atherosclerotic heart disease. J Hol Med.1981; 3:53–58.Google Scholar12 Clarke NE Sr, Clarke NE Jr, Mosher RE. Treatment of occlusive vascular disease with disodium ethylene diamine tetraacetic acid (EDTA). Am J Med Sci.1960; 239:732–744.CrossrefMedlineGoogle Scholar13 Kitchell JR, Palmon F, Aytan N, Meltzer L. The treatment of coronary artery disease with disodium EDTA. Am J Cardiol.1963; 11:501–506.CrossrefMedlineGoogle Scholar14 Lamar CP. Chelation therapy of occlusive arteriosclerosis in diabetic patients. Angiology.1964; 15:379–395.CrossrefMedlineGoogle Scholar15 Lamur CP. Chelation endarterectomy for occlusive atherosclerosis. J Am Geriatr Soc.1966; 14:272–294.CrossrefMedlineGoogle Scholar16 Nissel H. Arteriosklerose und Chelattherapie. Wien Med Wochenschr.1986; 136:586–588.MedlineGoogle Scholar17 Wirebaugh SR, Geraets DR. Apparent failure of coronary arteriosclerosis. DICP.1990; 24:22–25.CrossrefMedlineGoogle Scholar18 Scott PJ. Chelation therapy: evolution or devolution of a nostrum? N Z Med J.1988; 101:109–110.MedlineGoogle Scholar19 Scott PJ. Chelation therapy for degenerative vascular disease. N Z Med J.1982; 95:538–539.MedlineGoogle Scholar20 Robinson D. Chelation therapy. N Z Med J.1982; 95:750. Letter.MedlineGoogle Scholar21 Soffer A. Chelation clinics: an abuse of the physician's freedom of choice. Arch Intern Med.1984; 144:1741–1742.CrossrefMedlineGoogle Scholar22 Lyons RD. Chelation: miracle cure or false hope? Med J Aust.1985; 142:519–520.CrossrefGoogle Scholar23 Thompson LJ. Chelation therapy. N Z Med J.1990; 103:326–327.MedlineGoogle Scholar24 Patterson R. Chelation therapy and Uncle John. Can Med Assoc J.1989; 140:829–831.MedlineGoogle Scholar25 EDTA chelation: a rebutral. J Adv Med.1992; 5:3–5.Google Scholar26 Olszewer E, Sabbag FC, Carter JA. A pilot double-blind study of sodium-magnesium EDTA in peripheral vascular disease. J Natl Med Assoc.1990; 82:173–177.MedlineGoogle Scholar27 Guldager B, Jelnes R, Jørgensen SJ, Nielson JS, Klærke A, Morgensen K, Larsen KE, Reimer E, Holm J, Ottesen S. EDTA treatment of intermittent claudication: a double-blind, placebo-controlled study. J Intern Med.1992; 231:261–267.CrossrefMedlineGoogle Scholar28 Sloth-Nielsen J, Guldager B, Mouitzen C, Lund EB, Egeblad M, Nørregaard O, Jørgenson SL, Jelnes R. Arteriographic findings in EDTA chelation therapy on peripheral arteriosclerosis. Am J Surg.1991; 162:122–125.CrossrefMedlineGoogle Scholar29 van Rij AM, Solomon C, Packer SGK, Hopkins WG. Chelation therapy for intermittent claudication. Circulation.1994; 90:1194–1199.CrossrefMedlineGoogle Scholar30 Diagnostic and therapeutic technology assessment: chelation therapy. JAMA.1983; 250:672.CrossrefGoogle Scholar31 Rathmann KL, Golightly LK. Chelation therapy of atherosclerosis. Drug Intell Clin Pharm.1984; 18:1000–1003.CrossrefMedlineGoogle Scholar32 Perry W. Chelation therapy. Compl Ther Med.1994; 2:17–18.Google Scholar33 Rinse J. Arteriosclerosis, a plurideficiency disease. Am Chiropractor. 1987;Jan:16–28.Google Scholar34 Born GR, Geurkink TL. Improved peripheral vascular function with low dose intravenous EDTA. Townsend Lett.1994; 132:722–726.Google Scholar35 Meltzer LE, Kitchell JR, Palmon FJ. The long term use, side effects, and toxicity of disodium ethyldiamine tetraacetic acid (EDTA). Am J Med Sci.1961; 242:51–57.CrossrefMedlineGoogle Scholar36 Schellander F. Overview of chelation therapy. Int J Alt Compl Med.1992; 10:23–24.Google Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited ByRavalli F, Vela Parada X, Ujueta F, Pinotti R, Anstrom K, Lamas G and Navas‐Acien A (2022) Chelation Therapy in Patients With Cardiovascular Disease: A Systematic Review, Journal of the American Heart Association, 11:6, Online publication date: 15-Mar-2022. Seisenbaeva G, Ali L, Vardanyan A, Gary-Bobo M, Budnyak T, Kessler V and Durand J (2021) Mesoporous silica adsorbents modified with amino polycarboxylate ligands – functional characteristics, health and environmental effects, Journal of Hazardous Materials, 10.1016/j.jhazmat.2020.124698, 406, (124698), Online publication date: 1-Mar-2021. Хрыщанович В (2020) Diagnosis and Management of Peripheral Artery Diseases, Кардиология в Беларуси, 10.34883/PI.2020.12.3.009:3, (390-408), Online publication date: 13-Jul-2020. Villarruz-Sulit M, Forster R, Dans A, Tan F and Sulit D (2020) Chelation therapy for atherosclerotic cardiovascular disease, Cochrane Database of Systematic Reviews, 10.1002/14651858.CD002785.pub2 Hossain P, Kokkinidis D and Armstrong E (2019) How To Assess a Claudication and When To Intervene, Current Cardiology Reports, 10.1007/s11886-019-1227-4, 21:11, Online publication date: 1-Nov-2019. Mathew R, Schulman-Marcus J, Nichols E, Newman J, Bangalore S, Farkouh M and Sidhu M (2017) Chelation Therapy as a Cardiovascular Therapeutic Strategy: the Rationale and the Data in Review, Cardiovascular Drugs and Therapy, 10.1007/s10557-017-6759-5, 31:5-6, (619-625), Online publication date: 1-Dec-2017. Crisponi G, Nurchi V, Lachowicz J, Crespo-Alonso M, Zoroddu M and Peana M (2015) Kill or cure: Misuse of chelation therapy for human diseases, Coordination Chemistry Reviews, 10.1016/j.ccr.2014.04.023, 284, (278-285), Online publication date: 1-Feb-2015. Avila M, Escolar E and Lamas G (2014) Chelation therapy after the Trial to Assess Chelation Therapy, Current Opinion in Cardiology, 10.1097/HCO.0000000000000096, 29:5, (481-488), Online publication date: 1-Sep-2014. Sidhu M, Saour B and Boden W (2013) A TACTful reappraisal of chelation therapy in cardiovascular disease, Nature Reviews Cardiology, 10.1038/nrcardio.2013.176, 11:3, (180-183), Online publication date: 1-Mar-2014. Gornik H and Creager M (2013) Medical Treatment of Peripheral Artery Disease Vascular Medicine: A Companion to Braunwald's Heart Disease, 10.1016/B978-1-4377-2930-6.00019-7, (242-258), . King-Shier K, Quan H, Mather C, Verhoef M, Knutson M and Ghali W (2012) Understanding coronary artery disease patients' decisions regarding the use of chelation therapy for coronary artery disease: Descriptive decision modeling, International Journal of Nursing Studies, 10.1016/j.ijnurstu.2012.03.011, 49:9, (1074-1083), Online publication date: 1-Sep-2012. Park D (2012) Peripheral Vascular Disease Integrative Medicine, 10.1016/B978-1-4377-1793-8.00026-1, (237-246.e3), . Ernst E (2011) Fatalities after CAM: an overview, British Journal of General Practice, 10.3399/bjgp11X578070, 61:587, (404-405), Online publication date: 1-Jun-2011. Brandt J, Charron K, MacDonald S and Medley J (2011) Mass Gain Behaviour of Tibial Polyethylene Inserts during Soak Testing, Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, 10.1177/2041303310392629, 225:3, (324-331), Online publication date: 1-Mar-2011. Baohong G, Yuling L, Chenwei W, Yadong Z, Shengli W, Qiang Z and Baimei T (2010) A new cleaning process for the metallic contaminants on a post-CMP wafer's surface, Journal of Semiconductors, 10.1088/1674-4926/31/10/106004, 31:10, (106004), Online publication date: 1-Oct-2010. Brandt J, Brière L, Marr J, MacDonald S, Bourne R and Medley J (2010) Biochemical comparisons of osteoarthritic human synovial fluid with calf sera used in knee simulator wear testing, Journal of Biomedical Materials Research Part A, 10.1002/jbm.a.32728, 9999A, (NA-NA), . Aronow W (2009) Peripheral arterial disease in women, Maturitas, 10.1016/j.maturitas.2009.10.001, 64:4, (204-211), Online publication date: 1-Dec-2009. Dobesh P, Stacy Z and Persson E (2009) Pharmacologic Therapy for Intermittent Claudication, Pharmacotherapy, 10.1592/phco.29.5.526, 29:5, (526-553), Online publication date: 1-May-2009. Ernst E (2010) The cost of ignoring science, Focus on Alternative and Complementary Therapies, 10.1111/j.2042-7166.2009.tb01852.x, 14:1, (1-2), Online publication date: 1-Mar-2009. Ernst E (2009) Politics of alternative medicine, International Journal of Clinical Practice, 10.1111/j.1742-1241.2008.01982.x, 63:3, (516-516), Online publication date: 1-Mar-2009. Watson L, Ellis B, Leng G and Watson L (2008) Exercise for intermittent claudication Cochrane Database of Systematic Reviews, 10.1002/14651858.CD000990.pub2 Aronow W (2008) Management of Peripheral Arterial Disease in the Elderly Cardiovascular Disease in the Elderly, 10.3109/9781420061710.029, (749-768), Online publication date: 1-Feb-2008. Kotani Y, Nakajima Y, Hasegawa T, Satoh M, Nagase H, Shimazawa M, Yoshimura S, Iwama T and Hara H (2007) Propofol Exerts Greater Neuroprotection with Disodium Edetate than without It, Journal of Cerebral Blood Flow & Metabolism, 10.1038/sj.jcbfm.9600532, 28:2, (354-366), Online publication date: 1-Feb-2008. Aronow W (2007) Management of Peripheral Arterial Disease of the Lower Extremities, Comprehensive Therapy, 10.1007/s12019-007-8013-8, 33:4, (247-256), Online publication date: 9-Nov-2007. Quan H, Galbraith P, Norris C, Southern D, King K, Verhoef M, Knudtson M and Ghali W (2007) Opinions on chelation therapy in patients undergoing coronary angiography: Cross-sectional survey, Canadian Journal of Cardiology, 10.1016/S0828-282X(07)70225-8, 23:8, (635-640), Online publication date: 1-Jun-2007. Park D and Ring M (2007) Peripheral Vascular Disease Integrative Medicine, 10.1016/B978-1-4160-2954-0.50033-8, (309-321), . &NA; (2006) Aggressive risk factor modification and pharmacological therapy are the basic steps in managing peripheral arterial disease, Drugs & Therapy Perspectives, 10.2165/00042310-200622110-00005, 22:11, (17-20), Online publication date: 1-Nov-2006. Hirsch A, Haskal Z, Hertzer N, Bakal C, Creager M, Halperin J, Hiratzka L, Murphy W, Olin J, Puschett J, Rosenfield K, Sacks D, Stanley J, Taylor L, White C, White J, White R, Antman E, Smith S, Adams C, Anderson J, Faxon D, Fuster V, Gibbons R, Halperin J, Hiratzka L, Hunt S, Jacobs A, Nishimura R, Ornato J, Page R and Riegel B (2006) ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): A Collaborative Report from the American Association for Vascular Surgery/Society for Vascular Surgery,⁎Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease), Journal of the American College of Cardiology, 10.1016/j.jacc.2006.02.024, 47:6, (e1-e192), Online publication date: 1-Mar-2006. Arthur H, Patterson C and Stone J (2006) The role of complementary and alternative therapies in cardiac rehabilitation: a systematic evaluation, European Journal of Cardiovascular Prevention & Rehabilitation, 10.1097/00149831-200602000-00002, 13:1, (3-9), Online publication date: 1-Feb-2006. Aronow W (2006) Drug Treatment of Peripheral Arterial Disease in the Elderly, Drugs & Aging, 10.2165/00002512-200623010-00001, 23:1, (1-12), . Gornik H and Creager M (2006) Medical Treatment of Peripheral Arterial Disease Vascular Medicine, 10.1016/B978-0-7216-0284-4.50024-5, (271-292), . Seely D, Wu P and Mills E (2005) EDTA chelation therapy for cardiovascular disease: a systematic review, BMC Cardiovascular Disorders, 10.1186/1471-2261-5-32, 5:1, Online publication date: 1-Dec-2005. Vogel J, Bolling S, Costello R, Guarneri E, Krucoff M, Longhurst J, Olshansky B, Pelletier K, Tracy C, Vogel R, Vogel R, Abrams J, Anderson J, Bates E, Brodie B, Grines C, Danias P, Gregoratos G, Hlatky M, Hochman J, Kaul S, Lichtenberg R, Lindner J, O'Rourke R, Pohost G, Schofield R, Shubrooks S, Tracy C and Winters W (2005) Integrating Complementary Medicine Into Cardiovascular Medicine, Journal of the American College of Cardiology, 10.1016/j.jacc.2005.05.031, 46:1, (184-221), Online publication date: 1-Jul-2005. Aronow W (2005) Management of Peripheral Arterial Disease, Cardiology in Review, 10.1097/01.crd.0000126082.86717.12, 13:2, (61-68), Online publication date: 1-Mar-2005. &NA; (2005) Chelation therapy for heart disease, Journal of the American Academy of Physician Assistants, 10.1097/01720610-200501000-00010, 18:1, (58), Online publication date: 1-Jan-2005. van Weert H (2003) Cochrane of Kwakrane?, Huisarts en Wetenschap, 10.1007/BF03083459, 46:5, (642-643), Online publication date: 1-May-2003. Conners M and Money S (2002) Can claudication be improved with medication?, Seminars in Vascular Surgery, 10.1016/S0895-7967(02)70023-9, 15:4, (237-244), Online publication date: 1-Dec-2002. Dean S (2016) Pharmacologic treatment for intermittent claudication, Vascular Medicine, 10.1191/1358863x02vm447ra, 7:4, (301-309), Online publication date: 1-Nov-2002. Ernst E (2002) Reply, American Heart Journal, 10.1067/mhj.2002.125514, 144:5, (A2), Online publication date: 1-Nov-2002. Dans A, Tan F and Villarruz-Sulit E (2002) Chelation therapy for atherosclerotic cardiovascular disease, Cochrane Database of Systematic Reviews, 10.1002/14651858.CD002785 (2010) Chelation therapy does not benefit heart patients, Focus on Alternative and Complementary Therapies, 10.1211/fact.2002.00164, 7:2, (152-153) Laslett L (2002) Chelation Therapy: New Proof of Lack of Efficacy, Preventive Cardiology, 10.1111/j.1520.037X.2002.01515.x, 5:2, (92-93), Online publication date: 1-Apr-2002. Evans D, Tariq M, Sujata B, McCann G and Sobki S (2001) The effects of magnesium sulphate and EDTA in the hypercholesterolaemic rabbit, Diabetes, Obesity and Metabolism, 10.1046/j.1463-1326.2001.00154.x, 3:6, (417-422), Online publication date: 1-Dec-2001. Wood A and Hiatt W (2001) Medical Treatment of Peripheral Arterial Disease and Claudication, New England Journal of Medicine, 10.1056/NEJM200105243442108, 344:21, (1608-1621), Online publication date: 24-May-2001. Suarez T and Reese F (2000) Coping, psychological adjustment, and complementary and alternative medicine use in persons living with hiv and aids, Psychology & Health, 10.1080/08870440008405476, 15:5, (635-649), Online publication date: 1-Sep-2000. Norgren L (2000) Pharmacotherapy for critical limb ischaemia, Diabetes/Metabolism Research and Reviews, 10.1002/1520-7560(200009/10)16:1+ 3.0.CO;2-E, 16:S1, (S37-S41), Online publication date: 1-Sep-2000. Ernst E (2000) Chelation therapy for coronary heart disease: An overview of all clinical investigations, American Heart Journal, 10.1067/mhj.2000.107548, 140:1, (139-141), Online publication date: 1-Jul-2000. (2000) Other treatment modalities, European Journal of Vascular and Endovascular Surgery, 10.1016/S1078-5884(00)80045-3, 19, (S222-S225), Online publication date: 1-Jun-2000. Ernst E (2010) The British House of Lords' enquiry into complementary and alternative medicine, Focus on Alternative and Complementary Therapies, 10.1211/fact.2000.00002, 5:1, (3-5), Online publication date: 1-Mar-2000. Veeramah E and Holmes S (2016) Complementary therapy: complement or threat to modern medicine?, Journal of the Royal Society for the Promotion of Health, 10.1177/146642400012000117, 120:1, (42-46), Online publication date: 1-Mar-2000. Szapary P and Mohler E (2000) Alternative medicine in cardiovascular disease, ACC Current Journal Review, 10.1016/S1062-1458(00)00047-7, 9:2, (104-108), Online publication date: 1-Mar-2000. (2000) Other treatment modalities, Journal of Vascular Surgery, 10.1016/S0741-5214(00)81045-9, 31:1, (S263-S267), Online publication date: 1-Jan-2000. Green D, O'Driscoll J, Maiorana A, Scrimgeour N, Weerasooriya R and Taylor R (1999) EFFECTS OF CHELATION WITH EDTA AND VITAMIN B THERAPY ON NITRIC OXIDE-RELATED ENDOTHELIAL VASODILATOR FUNCTION, Clinical and Experimental Pharmacology and Physiology, 10.1046/j.1440-1681.1999.03156.x, 26:11, (853-856), Online publication date: 4-Nov-1999. Bartholomew J and Gray B (1999) LARGE ARTERY OCCLUSIVE DISEASE, Rheumatic Disease Clinics of North America, 10.1016/S0889-857X(05)70092-2, 25:3, (669-686), Online publication date: 1-Aug-1999. Gibbons R, Chatterjee K, Daley J, Douglas J, Fihn S, Gardin J, Grunwald M, Levy D, Lytle B, O'Rourke R, Schafer W, Williams S, Ritchie J, Gibbons R, Cheitlin M, Eagle K, Gardner T, Garson A, Russell R, Ryan T and Smith S (1999) ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina11This document was approved by the American College of Cardiology Board of Trustees in March 1999, the American Heart Association Science Advisory and Coordinating Committee in March 1999, and the American College of Physicians-American Society of Internal Medicine Board of Regents in February 1999.When citing this document, please use the following citation format: Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM, Grunwald MA, Levy D, Lytle BW, O'Rourke RA, Schafer WP, Williams SV. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). J Am Coll Cardiol 1999;33:2092–197.This document is available on the World Wide Web sites of the American College of Cardiology (www.acc.org) and the American Heart Association (www.americanheart.org). Reprints of this document are available by calling 1-800-253-4636 or writing the American College of Cardiology, Educational Services, at 9111 Old Georgetown Road, Bethesda, MD 20814-1699. Ask for reprint number 71-0166. To obtain a reprint of the Executive Summary and Recommendations published in the June 1, 1999 issue of Circulation, ask for reprint number 71-0167. To purchase bulk reprints (specify version and reprint number): Up to 999 copies call 1-800-611-6083 (US only) or fax 413-665-2671; 1000 or more copies call 214-706-1466, fax 214-691-6342, or e-mail [email protected], Journal of the American College of Cardiology, 10.1016/S0735-1097(99)00150-3, 33:7, (2092-2197), Online publication date: 1-Jun-1999. (1998) Chelatietherapie bij perifeer arterieel vaatlijden, chelatietherapievaatlijden: doorspoelen maar, Medisch-Farmaceutische Mededelingen, 10.1007/BF03057217, 36:11, (245-245), Online publication date: 1-Nov-1998. August 5, 1997Vol 96, Issue 3 Advertisement Article InformationMetrics Copyright © 1997 by American Heart Associationhttps://doi.org/10.1161/01.CIR.96.3.1031 Originally publishedAugust 5, 1997 Keywordschelation therapyperipheral vascular diseasearteriosclerosis Advertisement
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