Tuesday, November 26, 2013


Now that I am back on ground and in Subang, I can start to post again. I had a fair bit of travelling from PD to Bangkok to Manila, on social duty. Have now managed to clear the backlog and ready for tomorrow's teaching in UTAR.

Well, I am also catching up on my literature reading.
Two weeks ago, the American Heart Association held their Annual Scientific meeting at Dallas. Amongst the many trials presented was a follow-up of the TACT ( Trial to Assess Chelation Therapy ), in the subset of diabetics.
If you recall, TACT, lead investigator Dr Gervatio Lamas of Mt Sinai Medical Center, Florida, was a study to assess the benefits of chelation therapy, a very controversial form of chemical therapy to clear coronary artery blockages. The results of the trial was presented at AHA 2012. They studied about 1,708 patients and followed up for 4 years. All patients were 50 years and above and had a prior heart attack. Patients were divided to two groups, the chelation group and the placebo group. They all received 40 sessions ( 3 hrs per session ) of IV therapy. In the treatment arm, the therapy was IV EDTA + acorbic acid + Magnesium Chloride + potassium chloride + sodium bicarbonate + B vitamins + procainamide + a small amount of heparin.
After 4 years of followup, the main study ( AHA 2012 ) showed that chelation therapy had some benefit in terms of the primary endpoint, but the p-value was weak ( just significant ). Remember, this trial was filled with controversies and took a long time to complete and had the protocol change a few times. So the marginal benefit was quickly dismissed as not conclusive.
Well, at AHA 2013, Dr Estaban Escolar, also from Mt Sinai MC, Florida, presented further analysis of the sub group of diabetics who also underwent chelation therapy. There were 633 patients who had completed the 40 sessions at 3hours per session and had been followed up for 4 years. They found that in this diabetic subgroup, there was a 40% reduction in the primary MACE endpoint, a 40% reduction in AMI, a 50% reduction in diabetic deaths. Now these are very significant numbers. No longer marginal or borderline.
Does chelation therapy really works, especially in diabetics? If so, then how?
It is very interesting to postulate that they may reduce AGE ( Advanced Glycation End Products ) and so atherosclerosis and other degenerative processes. However the evidence of this is lacking.
Of course the next intuition is to have a bigger study ( probably in the thousands ) of diabetics on chelation therapy. But who will fund? But treating 6.5 patients to save 1 life over 5 years, sounds like a good bargain to me.

I must say that I was initially ( that is over the last 20 years ), very very sceptical about this form of therapy. I felt that it was quack medicine. With this TACT sub-study, I may have to pay more attention to the literature. I still do not think that it is true, but I sure cannot simply dismiss it.
Each of you may have to decide for yourself n this one. I am a bit confused.

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