Angeloni et al398 noted that all-cause mortality was 50% higher in those patients with metabolic syndrome com- pared with those without in a long-term follow-up study of 1726 CABG patients. The metabolic syndrome also increased the long-term risk for cardiac arrhythmias, renal failure, and the composite outcome of major adverse cardiovascular events Patients with the meta- bolic syndrome are 2.3-times more likely to develop AF after This increased risk may be mediated by an elevated C-reactive protein level.401 Patients with metabolic syndrome are also at risk for decreased patency of saphenous vein grafts Given the multiple pathophysiological mechanisms link- ing obesity and cardiovascular disease, it is logical to expect favorable clinical outcomes after weight loss in patients with CAD. Unfortunately, there is minimal evidence proving any benefit associated with weight loss after CABG. Retrospective, observational studies assessing the association between weight loss and clinical outcomes after CABG have shown para- doxical results, with worse outcomes among patients losing weight after CABG.403 However, these studies could not dif- ferentiate between purposeful and unintentional weight loss. Unintentional weight loss could reflect comorbidities such as heart failure, cancer, and lung diseases or may reflect the sever- ity of other conditions associated with decreased survival. One of the few studies that showed improved outcomes after weight loss in patients with CAD was based in a CR setting, suggest- ing that purposeful weight loss in CAD patients may be benefi- Weight loss has an indisputable benefit for BP, diabetes mellitus, and lipid control and improves quality of life and functional capacity. Therefore, despite the limited scientific evidence, it is generally accepted that weight loss should be recommended for overweight or obese patients after CABG. Long-term, successful weight loss continues to represent a major clinical challenge. 