REN and obesity due to melanocortin 4 receptor deficiency: Several potential mechanisms accounting for protective effects of obesity on clinical outcomes after AMI have been proposed; greater metabolic reserves, less cachexia, younger ages, more aggressive medical therapy, more aggressive diagnostic and revascularization procedures, increased muscle mass and strength, diminished hormonal response including the renin-angiotensin-aldosterone system, and unmeasured confounders, including selection bias [25].