Chelation deserves another look
DEAR DOCTOR K: I have heart disease, and I keep hearing that chelation therapy can help. It sounds like snake oil to me. What is it, and can it help?
DEAR READER: Ever since I graduated from medical school, I’ve thought, like you, that chelation therapy for heart disease sounded like snake oil. Many of my patients have asked about it, and I’ve told them not to consider it. About a year and a half ago, a reader asked me the same question, and I was pretty negative in my column.
But I’ve learned that a doctor has to be open-minded: If new evidence runs counter to what you’ve believed, you need to consider it seriously. Evidence in the past two years has led me to think there may be something to chelation therapy.
So what is chelation (pronounced key-LAY-shun) therapy? Certain chemicals are injected into the blood. These chemicals attach to metals deposited in the tissues of your body, pulling the metals out of the tissue and into the blood. Then the metals get eliminated in your urine.
That may sound a little wacky, but it’s absolutely true. Chelation therapy is a successful treatment for lead poisoning, for example. But what does it have to do with heart disease?
Heart disease is the No. 1 cause of premature death. The most common form of heart disease results from atherosclerosis, in which fatty plaques build up inside artery walls. They block blood flow and increase the risk of a heart attack. These plaques contain calcium.
About 70 years ago, some doctors put forward a new theory, proposing that chelation therapy would pull the calcium out of the plaques and that would somehow ease heart problems. Mind you, there was no serious evidence to support this theory, but hundreds of thousands of people have received chelation therapy anyway. And the treatment can cause serious adverse reactions, including death. So you can understand why I, along with most doctors, have been skeptical about chelation therapy for heart disease.
What’s been missing is the gold standard for determining if a treatment works: a large, randomized, controlled trial. In the summer of 2013, a trial including more than 1,700 people who underwent chelation therapy was reported. The study participants were over age 50 and had recently had a heart attack, so the point of the trial was to find out if the people had fewer additional heart problems in the future.
The result was ambiguous: The patients receiving the true chelation therapy had a 4 percent lower risk of heart problems. The result was not dramatic enough to cause the doctors conducting the study to recommend the treatment.
Then another analysis of the results of the same study was published in early 2014. This analysis looked only at the people in the study who also had diabetes. These results were more dramatic: Heart problems were reduced by 41 percent in the people treated with chelation therapy. The study authors suggested that another randomized controlled trial be conducted just in people with heart disease and diabetes to verify the result.
So, in my opinion, the value of chelation therapy for heart disease remains to be proved. I used to think it was total baloney, but now I’m open to the idea that it may help some people, and that this possibility should be studied. I’ll report any further developments in a future column.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.