The obesity paradox (morbidity and mortality decreases as body mass index increases) was tested in a cohort of 22,576 treated hypertensive patients with coronary artery disease followed for 2.7 years. Of the 22,576 patients, 2.2% were thin, 20.0% were normal weight, 39.9% were overweight, 24.6% had class I obesity, and 13.2% had class II to III obesity. Using patients with normal body weight as the reference group, the risk of the first occurrence of all-cause mortality, nonfatal myocardial infarction, and nonfatal stroke was lower in overweight and obese (class I to III) patients, while thin patients were at greater risk. These results were observed even though patients with class I obesity showed the smallest reductions in blood pressure. They provide evidence that body mass index may not always discriminate risk of morbidity and mortality in certain subgroups of high-risk patients.
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