The purpose of this study is to determine if rimonabant 20 mg once daily (od) administered during 18-20 months will reduce progression of coronary atherosclerosis as assessed by intravascular ultrasound (IVUS) when administered on top of standard behavioral and pharmacological therapy given as needed, in patients with abdominal obesity associated with current smoking and/or metabolic syndrome.

Inclusion Criteria:

• Written and signed informed consent
• Indication for coronary angiography
• Abdominal obesity defined by waist circumference > 88 cm in women or > 102 cm in men
• At least one of the two following conditions: *a) Metabolic syndrome as defined by the presence of at least two of the following additional risk factors: 1. Triglyceride level >= 150 mg/dL (1.69 mmol/L); 2. HDL cholesterol < 40 mg/dL (1.03 mmol/L) [men] or 50 mg/dL (1.28 mmol/L) [women]; 3. Fasting glucose >= 110 mg/dL (6.1 mmol/L); 4. High blood pressure (>= 140 mmHg systolic and/or >= 90 mmHg diastolic) at Screening visit, or current treatment by anti-hypertensive medication; *b) Currently smoking (> 10 cigarettes /day) and willing to stop
• Angiographic evidence of coronary heart disease as defined by at least 1 lesion in a native coronary artery that has >= 20% reduction in lumen diameter by angiographic visual estimation
• Presence of at least one coronary artery complying with the definition of "target vessel" for IVUS assessment
• Acceptation of the Baseline IVUS tape by the IVUS Core Laboratory

Exclusion Criteria:

• Age < 18 years
• Pregnant or breast-feeding women
• History of very low-calorie diet or surgical procedures for weight loss (eg, stomach stapling, bypass) within 6 months prior to screening visit
• Obesity of known endocrine origin
• Uncontrolled diabetes with HBA1c >10%
• Presence of any severe medical or psychological condition, that in the opinion of the Investigator would compromise the subject's safety or successful participation in the study
• Severe congestive heart failure (New York Heart Association [NYHA] Class III or IV)
• Clinically significant heart disease which in the opinion of the Investigator is likely to require coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), cardiac transplantation, surgical repair and/or replacement during the course of the study
• Angioplasty of a non-qualifying artery which is considered at high risk of acute complication or restenosis, during baseline catheterization
• >50% reduction in lumen diameter of the left main coronary artery by visual angiographic estimation
• Recent ST-elevation myocardial infarction (MI) <= 72 hours prior to randomization