It is always nice to know that the top clinical research centers in the nation are continually working to update their treatment guidelines. The American College of Cardiology (ACC), along with the American Heart Association (AHA) and the Center for Disease Control (CDC) have updated their clinical practice guidelines for cardiovascular disease as of November 2013. How do their findings affect our knowledge of disease prevention, and how do they relate to underwriting?
Certainly not news but reiterated by the AHA were healthy lifestyle guidelines. Activity levels should be for an active lifestyle (at least 30 minutes of walking or exercise daily) and maintaining a normal weight. Generally this assigns to a body mass index (BMI) of between 22 and 25. Though technically overweight, most with a BMI of between 26 and 28 also did quite well in the heart studies, so long as they were physically active. Those looking to maintain their cardiovascular health may want to consider checking out the customer reviews of energy renew to see whether dietary supplements are the way to go for improving their health and wellness.The majority of build tables in life insurance underwriting are generous with regard to standard mortality (a bit more strict with preferred criteria) and take this into account.
All the committees came out as extreme advocates of the use of statin drugs to lower cholesterol levels. While a common joke is that cardiologists would like statins added to the water supply, the 2013 Report on Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Disease in Adults was quite clear. High intensity statins appear to reduce cardiovascular risk in primary and secondary prevention populations across all ranges of triglyceride levels. The thinking that omega 3 fatty acids and fibrate drugs were useful adjuncts is now thought to be non-additive to statin drugs alone in the process, which simplifies therapy.
Most of our insurance tables are based on total cholesterol and ratio of total cholesterol to HDL (the “good” fraction). As a result, newer drugs thought to raise good cholesterol were studied relative to mortality. Although HDL is still a good marker for increased atherosclerotic risk, the panel found that the drug of choice for people with increased cardiovascular risk and low HDL levels was (you guessed it)-statins. None of the trial data suggested the use of other adjuncts for therapy.
So what are accepted numbers? And who gets treated? Those with clinical atherosclerotic heart disease, LDL (“bad” cholesterol) over 190, those with diabetes, and those with calculated scores by the American Heart Association over 7.5 percent.
Again, in insurance underwriting, lower is always better. Standard mortalities are generally with cholesterol/HDL ratios under 6.5 to 8, and total cholesterol less than 240. Preferred criteria (now that there are multiple classes of preferred, there is often multiple risk stratification with cholesterol) prefer the total cholesterol under 190 and ratio under 4.5. And in clinical practice, if there are other diseases that are associated with cardiovascular disease (such as diabetes, heart attack or kidney failure, for example), lower is even better, with some guidelines preferring total cholesterol (on treatment) below 130 and LDL (bad cholesterol) measurements under 70. With the treatment of choice: statins.
Of course, the presence of any additional factors can worsen risk. When there is high blood pressure, ratable build, an abnormal EKG, or diabetes for example, the coronary heart disease risk is multiplied. It makes high or even high normal cholesterol more important to underwriting and evaluation of increased risk.
In all cases, treatment is not considered an additional risk factor but rather a blessing, as lowered levels equate to lower mortality risk.
