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J Clin Endocrinol Metab. 2019 Mar 14. pii: jc.2018-01484. doi: 10.1210/jc.2018-01484. [Epub ahead of print]

Potential Role of Metal Chelation to Prevent the Cardiovascular Complications of Diabetes.

Author information

1
From the Mount Sinai Medical Center Department of Medicine, Miami Beach, FL.
2
Columbia University Mailman School of Public Health, New York, New York.
3
Department of Medicine, Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach FL.
4
Diabetes Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
5
Department of Medicine, New York University School of Medicine, New York, New York.
6
Roanoke Heart Institute PLC, Roanoke, Virginia.
7
Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana.

Abstract

CONTEXT:

For decades, there has been epidemiologic evidence linking chronic toxic metal exposure with cardiovascular disease, suggesting a therapeutic role for metal chelation. Given the lack of compelling scientific evidence however, the indications for metal chelation were never clearly defined. To determine the safety and efficacy of chelation therapy, the National Institutes of Health funded the Trial to Assess Chelation Therapy (TACT). TACT was the first double blind, randomized, controlled trial to demonstrate an improvement in cardiovascular outcomes with edetate disodium therapy in patients with prior myocardial infarction. The therapeutic benefit was striking among the pre-specified subgroup of diabetic patients.

EVIDENCE ACQUISITION:

We review the published literature focusing on the atherogenic nature of diabetes, and available evidence from clinical trials, complete and in progress, of metal chelation with edetate disodium therapy in diabetic patients.

EVIDENCE SYNTHESIS:

The TACT results support the concept that ubiquitous toxic metals such as lead and cadmium may be modifiable risk factors for cardiovascular disease, particularly in diabetic patients.

CONCLUSIONS:

The purpose of this review is to discuss the potential mechanisms unifying the pathogenesis of atherogenic factors in diabetes with toxic metal exposure, and the potential role of metal chelation.

PMID:
30869793
DOI:
10.1210/jc.2018-01484

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