There are definitely some consequences. These mainly come in the form of images, especially when they're meant to stretch across the entire post area. This is easy to correct with something like this in your code (themes should already do this anyway):
Code:
.post {
overflow: hidden; /* Hide overly large images in IE6 */
}
.post img {
max-width: 600px; /* What's the maximum width an image can be? */
}
You'd probably want to do the same for captions.
I like to always go big. If you've used a layout with a 400px post area for a year then bump up to 600px, you might have images that look funny because they're too small. But, if you use a 600px layout and go smaller, you can always shrink the images to size.