The purpose of this study was to examine the association between body mass index (BMI) and survival according to the type of treatment in patients with confirmed coronary artery disease (CAD). A total of 31 021 patients of the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) registry followed for 46 months were grouped according to six BMI categories and by treatment strategy: medical management only, percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). In the medically managed, PCI and CABG groups, significant lower mortality rates were observed in participants with BMIs of 25.0-29.9 kg/m2 and 30.0-34.9 kg/m2, 35.0-39.9 kg/m2 and 30.0-34.9 kg/m2, respectively. Overweight and moderately obese patients with established CAD had a reduced mortality compared to normal BMI patients (18.5-24.9 kg/m2) irrespective of the treatment strategy. Patients who were overweight or moderately obese were also more likely to undergo revascularisation procedures despite having a lower risk coronary anatomy. This inverse relationship between excess weight and cardiovascular mortality is in line with previous reports but is still surprising given the epidemiological link between obesity and cardiovascular disease. This “obesity paradox” seen in CAD patients remains to be further studied.
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