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Background. Roux-en-Y gastric bypass (RYGB) lowers cardiac risk through weight loss and improvement of biochemical cardiac risk factors (BCRF). We hypothesize improvement of BCRF for adolescents and adults alike. Methods. At a single academic institution,2004 to 2010, we measured BCRF in both adults and adolescents undergoing RYGB. Markers included: hemoglobin A1C (hA1C) total cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride/HDL ratio, lipoprotein A (LpoA), high-sensitivity C-reactive protein (CRP), and homocysteine and were measured preoperatively and 12 months postoperatively. The two groups were matched by body mass index (BMI), gender and number of complications. Data were analyzed using Student t-tests, Pearson’s correlations and ANOVAs where appropriate. Results. For 99 adults: mean age at surgery was 44.4 years; mean BMI was 52.3% kg/m2; 73.7% were female; 68.7% were hypertensive; 47.5% were diabetic; 58.8% had hyperlipidemia; and 60% had obstructive sleep apnea (OSA). The average number of comorbidities was 5.5. For 33 adolescents: mean age at surgery was 17 years; mean BMI was 52.7% kg/m2; 75.8% were female; 81.8% were hypertensive; 12.1% were diabetic; 78.7% were non diabetic but hyperinsulinemic; 51.5% had hyperlipidemia; and 73% had OSA. Preoperatively, between adults and adolescents respectively, there was a significant difference in hA1C (6.36 vs 5.59, p < 0.001), triglyceride (152.9 vs 112.8, p=0.005), triglyceride/HDL ratio (4.05 vs 3.00, p=0.018), CRP (13.4 vs 8.9, p=0.036) and homocysteine (10.5 vs 8.3, p< 0.001). There was a trending difference in preoperative total cholesterol levels between adults and adolescents (182.9 vs 164.8, p=0.007). At 12 months postop, there was a significant difference only in LpoA levels between adults and adolescents (38.6 vs 11.7, p<0.001). There was a trending difference in hA1C (5.54 in adults vs 5.35 in adolescents, p=0.079) and triglyceride/HDL ratio (2.21 in adults and 1.74 in adolescents, p=0.074). Between preop and 12 months postop, there were significant differences in the percent change of the following markers (compared adults vs adolescents): HDL (19.3% in adults vs -4.8%, p=0.009); homocysteine (-26.7% vs -3.6%, p=0.050); and fasting insulin (8.48% vs -408%, p<0.001). Between adults and adolescents, there was a trending difference in the percent change in LDL (-17.8 vs -37.7, p=0.075) and CRP (-1880% vs -882%, p=0.084) from preop to 12 months post op. Conclusion. Our study demonstrates significant differences in both the preop levels and percent change (from preoperative to 12 month time points) of BCRF between adults and adolescents. Between preop and 12 months post op, adolescents were more likely to experience a greater improvement in HDL, homocysteine, and fasting insulin than adults of similar BMI and comorbidities.