Lamelas P, et al. - Researchers tested the premise that the impact of higher body mass index (BMI) in patients with cardiovascular disease (CVD) varies by the individual's baseline risk of death. They performed data analysis for 170,470 individuals (22.8% without CVD, 29.4% with stable CVD and 47.8% with acute coronary syndromes [ACS]) using information from 14 prospective studies in 50 countries. They observed an association of higher BMI with a lower risk of death in higher risk groups between and within cohorts of people without CVD, stable CVD and ACS. In high-risk groups, the hazards may be counteracted by the benefits of increased body fat (ie, increased caloric reserve). This could be an alternative explanation of the obesity paradox.