Central illustration. Heavy metals as a risk factor for atherosclerotic cardiovascular disease and the benefits of chelation therapy. Major sources and routes of exposure, mechanisms at the molecular and cellular level, responses at the tissue and organ level, and subclinical and clinical cardiovascular effects on the basis of experimental and epidemiological evidence are shown for lead and cadmium. Arrows denote direction of flow. Na2EDTA, disodium ethylene diamine tetra acid; NO, nitric oxide; TACT, Trial to Assess Chelation Therapy.