Key result
Chelation therapy cuts cardiac events ~41% in patients with diabetes and prior MI.
Why the study?
Does chelation therapy reduce adverse cardiovascular events in patients with atherosclerotic disease, particularly those with diabetes and prior MI?
Does chelation therapy reduce adverse cardiovascular events in patients with atherosclerotic disease, particularly those with diabetes and prior MI?
Number Needed to Treat: 6.5
Number Needed to Treat: 6.5
p-value: p=0.0002
Chelation therapy may significantly reduce cardiovascular events in post-MI patients with diabetes, supporting its revised class IIb recommendation in ACC/AHA guidelines.
May support chelation in diabetic post-MI patients; leaves open confirmation in contemporary RCTs.
INTRODUCTION: Case reports and case series have suggested a possible beneficial effect of chelation therapy in patients with atherosclerotic disease. Small randomized trials conducted in patients with angina or peripheral artery disease, however, were not sufficiently powered to provide conclusive evidence on clinical outcomes. AREAS COVERED: The Trial to Assess Chelation Therapy (TACT) was the first randomized trial adequately powered to detect the effects of chelation therapy on clinical endpoints. We discuss results and future research. Expert commentary: Chelation reduced adverse cardiovascular events in a post myocardial infarction (MI) population. Patients with diabetes demonstrated even greater benefit, with a number needed to treat of 6.5 patients to prevent a cardiac event over 5 years, with a 41% relative reduction in risk of a cardiac event (p = 0.0002). These results led to the revision of the ACC/AHA guideline recommendations for chelation therapy, changing its classification from class III to class IIb. TACT2, a replicative trial, will assess the effects of chelation therapy on cardiovascular outcomes in diabetic patients with a prior myocardial infarction. We are seeking participating sites for TACT2.
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Lamas et al. (2016) conducted a review in Atherosclerosis, diabetes, post myocardial infarction. Chelation therapy was evaluated on cardiac event (41% relative reduction, p=0.0002). Chelation therapy reduced the risk of cardiac events by 41% over 5 years in patients with diabetes and prior myocardial infarction, with a number needed to treat of 6.5 (p=0.0002).
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