Obese people who have bariatric surgery to reduce weight generally see their cholesterol, blood pressure, and other heart-related risk factors improve afterward as the pounds come off. But ironically, obese people with a history of coronary artery disease often aren't referred for this surgery by their primary-care doctor or even by cardiologists for fear that they're risky candidates for a major operation. The concern is unnecessary, according to a study released yesterday in Mayo Clinic Proceedings.

Physicians tracked about 560 consecutive Mayo patients who had bariatric surgery from 1995 to 2002 for an average of 2½ years—some for more than six years. All were extremely obese, with an average body mass index of 50, indicating more than twice normal weight. Fifty-two of them had known heart disease. They'd had a heart attack, an untreated blockage, bypass surgery or stenting, or had experienced angina pain under stress.

The heart patients came through surgery and the follow-up period with flying colors, doing just as well as the others. There were no deaths in either group, and fewer patients in the heart group had complications.

"Contrary to what some might expect," says Mayo cardiologist Francisco Lopez-Jimenez, the study's lead author, "heart patients are not dying like flies after this major abdominal surgery."

Moreover, the procedure's success in reducing heart risk was clear from the numbers. Patients in the heart group lost more than half of their extra weight, reducing their body mass index to 36 on average. Their LDL cholesterol dropped from 116 milligrams per deciliter to 75 mg/dL, close to the recommended 70 mg/dL target for people with heart disease. And their blood pressure, triglycerides, and glucose fell as well, lowering their risk of diabetes and stroke.

"The pure fact of the matter is that millions of people qualify for this surgery," says Phillip Schauer, director of bariatric surgery at the Cleveland Clinic and incoming president of the American Society for Bariatric Surgery. "A lot of docs think it's too risky for people with heart problems, but surgeons know it's not."

Currently, the expense of bariatric surgery is covered by a growing number of insurers, especially if a patient's obesity can be tied to an accompanying medical condition such as cardiovascular disease or diabetes. The Mayo study could nudge a few more insurers into the coverage camp. And Medicare is evaluating the possibility of covering the surgery even if there is no accompanying condition.

If that happens, the volume of bariatric surgeries, which already has zoomed from fewer than 40,000 in 2000 to an estimated 140,000 in 2004 and is projected to rise to 171,000 this year, will accelerate even faster. The federal Centers for Medicare & Medicaid Services is due to put a proposal on the table in December, with a final decision possible next February.

Find out more: Check out the U.S. News Heart Center for more information on coronary artery disease.