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April 24, 2002

Chelation Therapy for Patients With Ischemic Heart Disease

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(16):2077-2078. doi:10.1001/jama.287.16.2073

To the Editor: Dr Knudtson and colleagues1 reported that chelation therapy with EDTA is no more effective than placebo in improving exercise time to ischemia, exercise capacity, and quality of life measurements in patients with ischemic heart disease.

There are several problems with this study. First, the control group was not treated with a true placebo. Intravenous ascorbic acid (an antioxidant) and magnesium (an antihypertensive) may both have had beneficial effects. Second, the authors dismissed the statistically significant improvement from baseline in exercise time to ischemia in both groups as "consistent with a combination of placebo and training effects commonly seen in studies of angina patients." If it takes so little to achieve a statistically significant improvement perhaps this should not have been used as the primary end point of the study. Use of a different end point could have allowed the inclusion of more than 650 patients who either could not walk on a treadmill or did not meet the treadmill test requirements. A more meaningful end point would have been cardiac events (ie, death, myocardial infarction, angioplasty, or coronary artery bypass graft surgery).

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