Division of Cardiology, Department of Medicine, Albany Stratton Veteran's Affairs Medical Centre and Albany Medical College, 113 Holland Avenue, Albany, NY 12208, USA.
Nat Rev Cardiol. 2014 Mar;11(3):180-3. doi: 10.1038/nrcardio.2013.176. Epub 2013 Dec 17.
Atherosclerotic cardiovascular disease (CVD) is highly prevalent and, despite therapeutic advances, remains a leading cause of morbidity and mortality. Many patients with CVD seek additional alternative therapies when symptoms are not controlled with evidence-based therapies. Although its therapeutic efficacy is unproven, chelation therapy with ethylenediamine tetra acetic acid (EDTA) is increasingly being used in patients with CVD. Early studies of chelation in atherosclerotic CVD provided the basis for the randomized Trial to Assess Chelation Therapy (TACT), in which chelation with disodium EDTA was compared with placebo in patients who had experienced a myocardial infarction. Here, we discuss the results, limitations, and implications of TACT in the context of other studies in the field. We believe that the findings from TACT are not robust and do not marshal evidence in support of the potential clinical use of chelation therapy for CVD, with the potential exception of certain high-risk cohorts such as patients with diabetes mellitus. Therefore, chelation is unlikely to become a widely-accepted approach until additional data are available.
动脉粥样硬化性心血管疾病（CVD）患病率很高，尽管治疗方法有所进步，但仍然是发病率和死亡率的主要原因。许多 CVD 患者在症状不能通过循证治疗得到控制时，会寻求额外的替代疗法。虽然螯合疗法的治疗效果尚未得到证实，但乙二胺四乙酸（EDTA）的螯合疗法在 CVD 患者中越来越多地被使用。早期关于动脉粥样硬化性 CVD 螯合作用的研究为随机评估螯合疗法试验（TACT）提供了基础，该试验比较了二钠 EDTA 螯合治疗与安慰剂在心肌梗死患者中的疗效。在这里，我们将根据该领域的其他研究，讨论 TACT 的结果、局限性和意义。我们认为，TACT 的发现并不稳健，也没有为螯合疗法治疗 CVD 的潜在临床应用提供证据支持，除了某些高危人群，如糖尿病患者。因此，在有更多数据可用之前，螯合治疗不太可能成为一种广泛接受的方法。
