REN and obesity due to melanocortin 4 receptor deficiency: Although the mechanism for the potential protective effect of obesity among patients with CAD remains unclear, a number of potential mechanisms have been proposed: greater metabolic reserves, less cachexia, younger presenting age, more aggressive medical therapy, more aggressive diagnostic and revascularization procedures, increased muscle mass and strength, possible improved cardiorespiratory fitness despite obesity, diminished hormonal response including the renin-angiotensin-aldosterone system, and unmeasured confounders, including selection bias [45].