Cardiovascular diseases (diseases of the heart or blood vessels) are the number one cause of death in the United States. The most common type of cardiovascular disease is coronary artery disease, in which the blood vessels that supply blood to the heart become narrowed or blocked.

• Several complementary health approaches have been studied to see whether they might help to control risk factors for cardiovascular disease, including high blood cholesterol and high blood pressure (hypertension).
  • Some dietary supplements, such as garlic and soy, may have beneficial effects on cholesterol, but their effects are small compared to those of cholesterol-lowering medicines.
  • There’s promising evidence that some complementary approaches, including meditation, tai chi, qi gong, and yoga as well as garlic, fish oil, flaxseed, and green or black tea, may have small beneficial effects on blood pressure.
  • If you have high cholesterol or high blood pressure, follow the treatment plan prescribed by your health care provider. Don’t replace your conventional treatment with other products or practices. Talk with your health care provider about any complementary approaches you’re considering.
• Chelation therapy using disodium EDTA (ethylene diamine tetra-acetic acid) is a controversial complementary health approach for coronary disease.
  • A large-scale National Institutes of Health (NIH)-sponsored study of chelation for coronary disease, called TACT (for Trial to Assess Chelation Therapy), showed evidence of a beneficial effect, but only in people with diabetes who had already had at least one heart attack. Because this was the first clinical trial to show such a benefit, its results are not, by themselves, sufficient to support the routine use of chelation as a post-heart attack therapy in people with diabetes.
  • A second NIH-supported study, called TACT2, is currently evaluating chelation therapy in people with diabetes who have had a heart attack to see if the apparent benefit can be confirmed.

Heart disease is the leading cause of death among both men and women in the United States. Coronary heart disease is the most common type of heart disease and is responsible for more than 370,000 deaths each year. Treatments include lifestyle changes (such as following a heart-healthy diet and quitting smoking), medicines, and medical procedures such as angioplasty.

Some heart disease patients also seek out chelation therapy using disodium EDTA (ethylene diamine tetra-acetic acid), a controversial complementary health approach. This page describes chelation for coronary heart disease and the research done on it, including two large studies funded by the National Institutes of Health (NIH).

What is chelation?

Chelation is a chemical process in which a substance is used to bind metals or minerals so they can be excreted from the body. Chelation has uses in conventional medicine, such as treating iron overload or severe lead poisoning. When it’s used as a complementary treatment for heart disease, a health care provider administers a solution of disodium EDTA in a series of infusions through the veins. A course of treatment can require 20 to 40 weekly infusions lasting several hours each. Patients also typically take high-dose pills of vitamins and minerals.

Is chelation for heart disease approved by the U.S. Food and Drug Administration (FDA)?

No. The use of EDTA chelation for heart disease has not been approved by the FDA.

As discussed below, a large-scale study of EDTA chelation for heart disease in people who have had a heart attack and who also have diabetes is currently in progress. When the study is completed, the FDA may use its results to help make a decision about whether to approve the use of EDTA chelation therapy for this purpose.

What has research shown about chelation for coronary heart disease?

• One large-scale study of chelation for coronary disease has been completed: the Trial to Assess Chelation Therapy (TACT), sponsored by the National Center for Complementary and Integrative Health (NCCIH) and the National Heart, Lung, and Blood Institute.
• The 1,708 people who participated in TACT were age 50 or older and had had at least one heart attack. They were randomly assigned to receive 40 treatments with EDTA or a placebo, plus either high-dose vitamins and minerals or placebo pills, and they did not know which treatment they were receiving.
• Overall, chelation therapy produced a modest reduction in cardiovascular events. However, further analysis showed that the beneficial effect occurred only in people with diabetes.
• People with diabetes, who made up about one-third of the participants, had a 41 percent overall reduction in the risk of any cardiovascular event; a 40 percent reduction in the risk of death from heart disease, nonfatal stroke, or nonfatal heart attack; a 52 percent reduction in recurrent heart attacks; and a 43 percent reduction in death from any cause over a period of about 5 years.
• The high-dose vitamins and minerals didn’t reduce cardiovascular events, but they appeared to be safe. However, the researchers couldn’t be completely certain about these conclusions because many people stopped taking their vitamin/mineral or placebo pills or dropped out of the study. When all four study groups (those receiving chelation treatments plus vitamins/minerals, chelation treatments plus placebo pills, placebo treatments plus vitamins/minerals, or placebo treatments plus placebo pills) were compared, the group receiving chelation plus vitamins/minerals had the fewest cardiovascular events and the group receiving placebo treatments and placebo pills had the most.
• Further research is needed to fully understand the TACT results. Since this is the first clinical trial to show a benefit of chelation, these results are not, by themselves, sufficient to support the routine use of chelation as a post–heart attack therapy in people with diabetes.

Is more research currently being done on chelation for coronary heart disease?

Yes. A large-scale study called Trial to Assess Chelation Therapy 2 (TACT2) is now in progress. Its purpose is to repeat the first TACT study—but only in patients with diabetes who have had a heart attack—to see if the apparent benefit can be confirmed. TACT2 is supported by NCCIH and other NIH agencies.

Can chelation therapy have side effects?

• Yes. The most important serious side effects are hypocalcemia (abnormally low blood calcium levels) and damage to the kidneys.
• In the TACT study, which had extensive safety monitoring, 16 percent of people receiving chelation and 15 percent of people receiving the placebo stopped their infusions because of an adverse event. Four of those events were serious; two were in the chelation group (one death) and two were in the placebo group (one death).

Do over-the-counter chelation products work? Are they safe?

• The FDA has warned the public not to use chelation products that are sold for home use, such as dietary supplements, nasal sprays, or suppositories. These products have not been approved to treat any health condition, and they may have serious side effects. They can also be harmful if people rely on them rather than seeking medical care for serious health problems.

More To Consider

• If you’re considering chelation therapy for coronary disease, discuss it first with your cardiologist or other health care provider. Seek out and consider information available from scientific studies on the therapy.
• Take charge of your health—talk with your health care providers about any complementary approaches you use. Together, you can make shared, well-informed decisions.

Omega-3 fatty acids are a group of polyunsaturated fatty acids that are important for a number of functions in the body. They are found in foods such as fatty fish and certain vegetable oils and are also available as dietary supplements. While experts agree that fish rich in omega-3 fatty acids should be included in a heart-healthy diet, there isn’t conclusive evidence that shows omega-3s have a protective effect against heart disease.

1. Experts agree that fish rich in omega-3 fatty acids should be included in a heart-healthy diet. Much research has been done on fish and heart disease, and the results provide strong, though not conclusive evidence that people who eat fish at least once a week are less likely to die of heart disease than those who rarely or never eat fish.

2. Omega-3s in supplement form have not been shown to protect against heart disease. While there has been a substantial amount of research on omega-3 supplements and heart disease, the findings of individual studies have been inconsistent. In 2012, two combined analyses of the results of these studies did not find convincing evidence that omega-3s protect against heart disease.

3. Omega-3 supplements may interact with drugs that affect blood clotting. Omega-3 supplements may extend the time it takes for a cut to stop bleeding. People who take drugs such as anticoagulants (“blood thinners”) or nonsteroidal anti-inflammatory drugs should discuss the use of omega-3 fatty acid supplements with a health care provider.

4. Fish liver oils (which are not the same as fish oils) contain vitamins A and D as well as omega-3 fatty acids; these vitamins can be toxic in high doses. Fish liver oils contain vitamins A and D as well as omega-3 fatty acids. Both of these vitamins can be toxic in large doses. The amounts of vitamins in fish liver oil supplements vary from one product to another.

5. Talk to your health care provider before using omega-3 supplements. If you are pregnant or nursing a child, if you take medicine that affects blood clotting, if you are allergic to fish or shellfish, or if you are considering giving a child an omega-3 supplement, it is especially important to consult your (or your child’s) health care provider.

In 2017, the American Heart Association (AHA) issued a scientific statement that meditation can reduce the risk of cardiovascular disease. The AHA council, which included several VA researchers, reviewed more than 400 scientific articles on meditation and found that medication can have long-standing effects on the brain, which may lower cardiovascular disease risk.

According to the AHA, meditation may be able to help with cardiovascular risk factors such as stress, smoking, high blood pressure, and various metabolic functions. More research is needed, however, according to the authors.

Stress creates an increased demand for oxygen throughout the body. In times of stress, your blood vessels are dilated (this means that they enlarge to let more blood through), you breathe more rapidly, and your body is ready to run—the “fight or flight” response. Your heart must work harder, beating faster to speed oxygen-rich blood to your extremities. The heart, as you know, is a muscle. All this hard work makes your heart larger, but in this case that isn’t a good thing. An enlarged heart is a weaker heart that doesn’t work as efficiently, so it can’t pump hard enough to deliver oxygenated blood to all of your extremities. Tissues may have too little oxygen to thrive or repair cells. The kidneys are one example of an organ in which lack of sufficient oxygenated blood can cause inefficient function and dangerous complications.

IMAGE: A comparison of a normal-sized (left image) and an enlarged heart (right image)

Stress can also contribute to irregularities in the electrical impulses that accompany each heartbeat. These complications create a greater risk of abnormal heart rhythms, heart failure, and heart attack in people with chronic stress.

As you’ve learned, your body responds to stress by producing the hormone cortisol. One of cortisol’s effects on the body is to raise blood glucose levels. This makes sense in the short term: It’s helpful to have quick energy available when an emergency arises. But chronic (long-term) stress creates chronically elevated glucose levels.

The cells that line blood vessels, known as endothelial cells, are very sensitive to glucose levels. When levels of blood glucose are very high, too much glucose ends up inside endothelial cells because these cells can’t limit their glucose uptake. The abnormally high glucose levels within the endothelial cells starts a whole chain of events that damages the cells in numerous ways and eventually kills them. And one thing is clear: Damage to the lining of the blood vessels creates a cascade of events that leads to cardiovascular disease.

One of the principle causes of cardiovascular disease is atherosclerosis, also known as hardening of the arteries. In atherosclerosis, lipid transporters (such as LDL-particles), calcium, and even our own protective white blood cells build up inside damaged blood vessel walls and form plaques. As plaques accumulate, they narrow blood vessel interiors and limit the flow of blood to cells and tissues, starving them of oxygen.

IMAGE: Fatty deposits build up inside arteries (left image) forming atherosclerotic plaques in the vessel wall (middle image). These plaque deposits can loosen and break off (right image).

Plaques may rupture and trigger blood clots. Blood clots can block blood flow if they stay in one place, or they may break off, travel through the vessels, and then become lodged in different places. If they lodge in the coronary arteries that feed the heart muscle, they can cause heart attacks. If the clot travels to the arteries that feed the brain, they may cause stroke.