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Matters of the Heart and Life Insurance

Did you know:

  • Cardiovascular disease is the number one cause of death in the United States, accounting for close to over 800,000 deaths per year. It is also the leading cause of death globally, accounting for more than 17 million deaths per year in 2013.
  • Heart disease is not exclusively a man’s problem: Heart disease is the number 1 killer of women as well.
  • About 92 million American adults are living with some form of cardiovascular disease or the after-effects of a stroke.

It’s no wonder people have taken to making lifestyle changes relative to fitness, diet and weight control with the aid of technology.

The wearable fitness device market— fitness trackers and smart watches that monitor among many things– heart health– has grown from 19 million units sold in 2014 to 70 million today, and is expected to continue to grow unit sales to 400 million by 2020. The market value of this segment is projected at $34 billion at that time. Indeed, if wearable fitness is any indication of the hyper focus on health and fitness, we may see significant changes in heart health statistics—and even life insurance underwriting– as a result.

Exercise, diet and weight are all very important when it comes to heart health–but don’t stop there.

In addition to lifestyle changes and a focus on fitness monitoring that can lead to modified behavior, people now have more affordable access to medications that help to lower cholesterol and blood pressure and prevent the development of blood clots– all risk factors in heart disease. These factors, when viewed together, can play a role not only in better health but in potentially more favorable life insurance pricing, as well.

According to Dr. Pieter Muntendam, President and CEO of G3 Pharmaceuticals in Boston and co-principal and developer of notable cardiovascular disease studies including BioImage, the largest consortium of industry-funded research on risk factors associated with heart attacks and stroke, “The most dramatic change we have seen is that we can now get LDL (bad cholesterol in our blood) to levels below 20mg/dL– levels we did not think possible (or healthy) in the past, using statins, drugs that manage cholesterol. The general guideline is to keep LDL below 100mg/dL.”

With statins being generic and low cost (Walmart offers a 90-day supply of Lovastatin at $10, it’s full price, for instance), Muntendam goes on to say, “There is no excuse for anyone to walk around with an elevated LDL.”  He emphasizes that “Age matters and taking heart medications as a preventive when you are young can go a long way in providing protection from heart disease. The moment you are in your 60’s, a lot of damage has been done.” His thinking is “if you have a 50-year old who has an LDL of 110 without meds and a 50-year old who has an LDL of 60 with meds, the general recommendation would be to take the meds. In other words, 60 is the new 100.”

Informed by more current clinical data and research, the American Heart Association (AHA) and the American College of Cardiology (ACC) changed the guidelines for measuring blood pressure in 2017. In the past, one would be considered as having high blood pressure, for example, at 140/90. Approximately 1/3 of the population was considered to have high blood pressure at this threshold. Today, the guideline has changed and has been lowered to 130/80.  This means that significantly more people today– half of the population, in fact—fall into this reading and have high blood pressure under the new guideline.

Muntendam also emphasizes making a distinction between what “average” and “normal” mean, compared to what “healthy” means.  He points out that “average means ‘what’s normal’ in the population, and normal is not desirable– nor can it be considered ‘healthy’.”

Because someone is diagnosed with normal coronary calcium, for example, doesn’t mean there’s a level of healthy calcium deposits. Calcification is another sign of atherosclerosis, coronary heart disease. “What’s better,” according to Muntendam, “is to have no calcification– and that is possible with medication.”

For your clients who are looking to get life insurance but who have a history of coronary heart disease, there’s hope. Carriers will consider the combination of risk factors in total– in addition to history.

For example, if there is a history of coronary heart disease and the client is not taking anti-platelet drugs, the client likely would be rated. However, if that same client is taking anti-platelets (like aspirin to prevent blood clots), beta blockers (to manage blood pressure) and a statin (to manage cholesterol) credits could be added to overall pricing to effectively lower the cost of coverage.  In some cases, carriers may provide preferred rates if medication is taken as a preventive without a history of heart disease—assuming no other medical issues.

What’s more- a healthy heart can play a role in lowering pricing for other ailments.  That is, a healthy cardiac risk profile can offset ratings for other impairments.  Many carriers have a program of credits they use to lower ratings, and the criteria related to a healthy heart is at the top of the list.  The credits can include regular aerobic exercise, excellent blood pressure, favorable pulse rate, an excellent lipid profile, a normal electrocardiogram, normal stress test, and a normal preventative heart screen (EBCT calcium score).

According to Bob Brookie, AVP and Chief Underwriter, Highland Capital Brokerage, “Life insurance carriers have traditionally focused on underwriting requirements that provide protective value in assessing potential heart disease, one of the most prevalent causes of early mortality.  The criteria include blood lipids, blood pressure, build, resting electrocardiograms (ECGs) and treadmill (stress) ECGs.”

However, Brookie explains that in an effort to reduce underwriting expense and to make the exam process less invasive, many carriers more recently have made changes to requirements, sometimes supported by their own proprietary statistical data. “Treadmill ECGs have been virtually eliminated and we also see carriers progressively eliminating resting ECGs”.

Further, new developments in blood tests have also helped carriers underwrite risks.  For example, heart failure and coronary artery disease cause elevations of a chemical known as NT-proBNP in the blood. According to Brookie, “Carriers have been testing the blood serum for NT-proBNP, which is released in the blood in increased amounts when the heart is stressed.  It is strongly predictive for early mortality at ages 50 and up.  When it is elevated carriers will increase the premium in proportion to the percentage of elevation if there is no documented heart disease.  If the disease is present, the NT-proBNP will be used as one of the determining factors in consideration with other cardiac testing and symptoms.  An abnormal level can adversely affect the outcome, but a normal level can often favorably impact the final offer.”

Finally, given the increased desire by clients to focus on fitness, make lifestyle changes and take preventive measures to manage their heart health– coupled with the potential to receive favorable underwriting status to boot — an ideal opportunity exists to conduct policy reviews to compare the costs and sustainability of older policies with the lower costs and potentially favorably underwritten newer ones—even when it come to matters of the heart.

  • Coronary Heart Disease is the leading cause of all cardiovascular disease (45.1%), followed by stroke (16.5%), heart failure (8.5%), High Blood Pressure (9.1%), diseases of the arteries (3.2%).
  • Coronary heart disease accounts for 1 in 7 deaths in the U.S, killing over 360,000 people per year.
  • Approximately 790,000 people per year in the US have heart attacks—of those, 114,000 will die
  • The estimated annual incidence of heart attack in the US is 580,000 new attacks and 210,000 recurrent attacks. The average age of first attack is 65.3 years for males and 71.8 years for females
  • Heart attacks ($11.5 billion) and Coronary Heart Disease ($10.4 billion) were 2 of the 10 most expensive hospital principal discharge diagnoses.
  • Between 2013 and 2030, medical costs of Coronary Heart Disease are projected to increase by 100%


Statistics taken from The American Heart Association’s 2017 Heart Disease and Stroke Statistics Update


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