In the MADIT (Multicenter Automatic Defibrillator Implantation)-II trial, there was an inverse relation between body mass index and both all-cause mortality and sudden cardiac death in patients with LV dys- function after MI.807 In the SYNERGY trial of 9837 patients with NSTEMI, mortality was lower in morbidly obese patients, consistent with the obesity paradox. 808 The obe- sity paradox has not been clarified and is under continuing investigation. Standard approaches to weight reduction in obese patients are usually unsuccessful in producing large decreases in weight. A weight reduction study of obese and morbidly obese patients following AMI resulted in weight loss of only 0.5% in obese patients and 3.5% in morbidly obese patients after 1 year.809 Two drugs, controlled-release are available for weight reduction but have not been studied in patients fol- lowing NSTE-ACS. Bariatric surgery has been successful in reducing cardiovascular risk factors, including diabetes mel- litus, hypertension, and dyslipidemia but has not been evalu- ated in post ACS patients.812 The 2013 obesity CPG provides comprehensive strategies for weight reduction.16 7.15. Patients Taking Antineoplastic/ Immunosuppressive Therapy Antineoplastic or immunosuppressive therapy may contrib- ute to the development of NSTE-ACS. For example, anti- neoplastic agents such as gemcitabine, sorafenib sunitinib, and 5-fluorouracil have been associated with coronary artery spasm or stenosis.813,814 Trastuzumab and possibly other anti- cancer drugs may alter biomarker levels.815 Antineoplastic agents can induce changes in the arterial wall,813 and modula- tors of inflammation may promote atherogenesis.816 In patients receiving these agents, it is prudent to communicate with the prescribing clinician about the necessity of their continuation during NSTE-ACS and future resumption. 8. Quality of Care and Outcomes for ACS Use of Performance Measures and Registries 8.1. Use of Performance Measures and Registries: Recommendation Class IIa 1. 