Obesity is a well-known cardiovascular risk factor in the general population, however studies have reported an inverse correlation between body mass index (BMI) and mortality in patients with cardiovascular disease. This association has been termed the “obesity paradox”. This retrospective study investigates the “obesity paradox” in a cohort of 529 patients with coronary artery disease registered in a cardiac rehabilitation and exercise training (CRET) program. In order to assess the impact of obesity on mortality in patients with coronary artery disease, a traditional index of obesity was used, BMI, as well as a more direct measure of adiposity such as percent body fat. Analyses with both measures revealed that total mortality was considerably lower in the baseline overweight/obese than in patients with baseline BMI <25 kg/m2 (4.1% vs. 13.2%; p<0.001), as well as in those with high baseline fat compared with those with low fat (3.8% vs. 10.6%; p<0.01). Additionnal results also revealed marked improvements in overall coronary risk factors for the overweight and obese coronary patients with greater weight loss. These data suggest that purposeful weight loss in overweight and obese coronary patients is not harmful and can lead to marked improvements in coronary risk factors.
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