Considering the apparent protective effect of obesity on the risk of mortality in patients with established coronary artery disease, this study examined the association between body mass index (BMI) and all-cause death within 5 years following first-time elective percutaneous coronary intervention (PCI). The cohort included 4880 patients of whom 219 deaths occured. The results were consistent with the “obesity paradox”, since overweight patients undergoing elective PCI for established coronary artery disease had a significantly lower risk of dying than normal weight patients even after adjustment for potential confounders. In their comment, Doehner W et al. describe the study of Hastie et al. as another manifestation of the “obesity paradox”. They also discuss the interesting explanations that the authors provided such as, the posibility that overweight and obese patients are investigated at an earlier stage and better treated for cardiovascular disease. Moreover, the editorial highlights the fact that the perception of obesity should be changed in certain circumstances and that the strategies concerning weight recommendations should be adjusted to the patients treated.
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