Obesity has a significant adverse effect on coronary heart disease (CHD) risk factors, including hypertension, dyslipidemia, and the metabolic syndrome/diabetes. Obesity is an independent risk factor for CHD events; however, obese patients with CHD generally have a more favorable prognosis, with the worst prognosis associated with either underweight or morbidly obese patients. In this manuscript, the authors review the impact of obesity on overall CHD risk as well as the prognosis of obese patients with established CHD.