Posts filed under 'coronary artery disease (CAD)'
In my passion to ensure that the world understands the risks of cancer, obesity and diabetes, I have often referred to heart disease, coronary artery disease, as a collateral health issue. What I have neglected to do is give the number one killer of men and women the singular emphasis it deserves.
Although women consistently note that their biggest health concern is breast cancer, it is heart disease that claims the most lives of any health issue that women face. According to a recent article in Pink Magazine by Michele Cohen Marill, “1 in 10 women ages 45-64 lives with heart disease”.
Probably because men have dominated the heart attack scenes in movies, very little coverage or concern has been given to the fact that women now outnumber men in the heart disease/heart attack statistics. The culprit in this switching of roles seems to be stress, and plenty of it.
We’ve talk many times about the impacts of stress on the body and the article really drives home that point by noting that “a Swedish study found that women are six times more likely to have a heart attack if they have a high pressure deadline at work”.
Oh, that we would all learn that life is just too short for that kind of stress. I understand why we do it. As a business owner I put more than my fair share of stress on myself. I hope I offset that stress with some balance in the form of daily exercise. My daily run is intentionally planned in the middle of my work day. It puts things back in perspective and the health benefits are a bonus. Vacations are critical. My wife and I have promised each other that play will be a part of our busy life.
I guess where I am going with this, is that a busy life, even stress, are OK as long as you find a counterbalance and don’t let it build up.
Bottom line. From a life insurance standpoint, heart disease, and especially early onset heart disease present an underwriting challenge. Bypasses and angioplasties aside, if the root cause isn’t changed, if your health condition isn’t addressed with the same passion that your career has been, you are headed down a road that will continue to worsen and life insurance underwriters will drive home that point in the rates they offer, or the declines they dish out.
As with all health issues, underwriters wants to see that you have made the changes, that you are committed to the treatment and that you have in mind not to add to the wrong side of the heart disease statistics. A heart attack can be just the wake up call a person needs. Even better, avoiding that heart attack by learning what changes you need to make in your life, and proactively taking the road less traveled.
January 21st, 2008
Even tempered that is! In case you haven’t been out of your house in the last 10 years, it is an increasingly angry society that we live in. That is one of the primary reasons I live in a small town. People are a little more laid back and things like road rage are really non existent.
Now anger is being talked about as a risk factor for heart disease. Makes sense to me. If you’ve ever noticed someone who is raging, the look as though they are about to blow a gasket, which is actually not a bad non medical definition for a heart attack.
The studies conclude that men with high anger traits are almost twice as likely to develop hypertension and nearly 50% more likely to develop coronary artery disease. These aren’t subtle differences. Angry people would appear to be on track to kills themselves via their own ability to let things slide.
Bottom line. Take a chill pill. Take time out to let the steam off slowly by relaxing. Before blowing up, take time to consider the situation and its’ true weight in your life and on the world. Ability to let go of anger will help you live a much happier and healthier life, and if you can reduce the risk of hypertension and heart attacks, it’s something of a no brainer to understand that you should be able to get better life insurance rates.
December 9th, 2007
We have discussed on numerous occasions the rapid increase of obesity in teenagers and the impact that has had on the increase of teenage and young adult type 2 diabetes. It is not a pretty picture that is being painted.
Now, the New England Journal of Medicine, has presented a study that paints a grim picture of early onset coronary artery disease (CAD), due to the high rate of teenage obesity carrying over into young adulthood.
What they found runs a little bit counter to a “good news” post within the past week where I reported that obesity seems to be leveling off, and with women even seems to have dropped some in the past few years. That good news was based on the adults of today.
If you extrapolate the rate of teen obesity today into adult obesity 20 years from now, it becomes obvious that unless something drastic happens, the leveling off we are experiencing now will disappear and obesity rates in adults will be substantially higher than they’ve over been.
So, let’s not kid ourselves. There is a very bad scenario starting to build and unless something is done, we will have dramatic increases of diabetes, cancer and heart disease in young adults, leading to mortality experiences that we haven’t seen in a very long time.
It won’t be easy to turn that trend around, but a start in the right direction may not be as tough as we think. A UCLA study recently found that, DUH, if you offer more fruits and vegetables in school, kids eat more fruits and vegetables. I have seen the results of several studies that show that kids will eat what they are offered at school, and that the saying “garbage in, garbage out” is right on the money in this case. Feed them junk and they will gain weight. Feed them healthy alternatives and they won’t.
Bottom line. Obesity doesn’t help your health or your life insurance rates as an adult. If you come into adulthood with a trend toward poor health already established, life insurance is going to be very difficult to get at all, let alone at good prices. But that is secondary to the impact it will have on your life and longevity.
December 8th, 2007
It’s been some time since I’ve just given a diabetes underwriting 101 overview. Some companies have changed stances, but overall the market remains somewhat consistent.
Underwriters look at type 2 diabetes from several directions. Age of onset is a fairly critical issue. The reason they closely scrutinize the age of onset is that the longer a person has diabetes, the better the chances that they will develop collateral health issues. So, the most favorable underwriting is for those whose age of onset is after age 50, not as favorable between 40 and 50 and pretty tough going if onset was prior to 40. It doesn’t mean that a person can’t get life insurance, but other risk factors need to be good or there is a chance of a decline.
The hbA1c level on your regular lab results is another big factor in how the diabetes is underwritten. Consistently well controlled (an A1c of 6.5 or less), with all other risk factors favorable, can get you better than standard rates. An A1c that runs between 6.5 and 7.0 should be able to pull standard rates, and in most cases 7.0 to 8.0 will get offers that would be rated (higher than standard). Over 8.0 is tough, but can be done if all risk factors are good. Over 9.0 isn’t going to fly until it comes down and you have a track record of keeping it down. By the way, if you are anticipating shopping for life insurance and don’t know your most recent A1c, call your doctor and find out. There is no way that an agent can accurately quote without it. I hate to lecture, but you should know this information anyway, and a shockingly large percentage don’t.
The risk factors are the other issue that plays into the final underwriting. Obesity, high blood pressure, protein in the urine, heart disease, etc, are all going to work against getting standard or better rates. The trend in the industry right now is that diabetes with coronary artery disease (CAD) is pretty much off limits. Protein in the urine…something is out of control.
Bottom line. Good rates and type 2 diabetes don’t have to be oxymorons. It can be done. The same thing that a diabetic educator will teach you are the same things that will give you your best shot at a long healthy life and coincidentally, the best shot at reasonable life insurance.
December 7th, 2007
In a post a few months ago I had mentioned the concern over studies that showed a potential link between the diabetes drug Avandia and heart attacks. Well, the FDA boldly stepped out and muddied the waters today in a way that only a government agency can do.
There are different levels or warning labels the FDA can require a company to put on a product. Probably the best known of these is the warning label in the black box on a pack of cigarettes. Well, Avandia now has a black box, sort of.
With the evidence inconclusive, but a clamor from scientific community to do something, the FDA has now officially added the warning “Avandia may be associated with “myocardial ischemic events such as angina or myocardial infarction”. Not IS associated or ISN’T associated, but may be associated.
I understand the need to cover your rear these days, but rather than put a completely ambiguous warning on the package, why not just tell doctors that, until further research is done, prescribing Avandia to patients with any signs of coronary artery disease should be avoided.
Bottom line. From a life insurance perspective, the last thing someone with type 2 diabetes needs is a cardiac event such as a heart attack. Depending on your age and the severity of the attack, it will kick you into a category that will either be highly rated or declined. If you have any concerns and are taking Avandia, ask your doctor if they can clarify the FDA warning.
November 14th, 2007
In a few previous posts I had discussed the heart imaging test called an Ultra Fast CT scan. Touted by those who own the machines as the best early warning device for coronary artery disease, the machines and the tests have also had a multitude of critics due to the number of false positive results.
The test is supposed to take a snapshot of the heart and it’s arteries, ultra fast, so that the heart muscle in motion can be stopped. It’s purported strong point is that it can show plaque buildup. Absent this snapshot, blockage would have to be detected by thallium stress tests or stress echocardiograms.
The big selling point of the ultra fast ct scan is that it can show blockage without an invasive procedure. Unfortunately, the only way to conclusively determine if there is blockage and how much, is to do a backup angiogram and actually look inside. The real unfortunate outcome is that the ct scan has been incorrect in about 50% of cases, making the invasive procedure a waste of time.
I recently had a client who was practically pronounced dead on his ultra fast ct scan. He ranked in the 97th percentile for chances of having a blockage induced heart attack. He had a backup thallium stress test that showed no blockage or abnormalites, so the cardiologist did not recommend an angiogram. The first life insurance company we took it to waffled a bit, but came back with a borderline acceptable offer. We shopped it further and today hit a home run, with the company throwing out the ultra fast ct scan as irrelevant in the presence of a perfect thallium stress test.
Bottom line. There are people criss-crossing the country selling ultra fast ct scans at $400 a pop. If you choose to spend that money and get bad results, get a back up stress test from an actual cardiologist. If you get good results but have some reason for concern such as family history, or having risk factors for heart disease such as high cholesterol, diabetes or obesity, see a cardiologist anyway.
September 25th, 2007
Episode 4, nearly 300 miles into their “march”, I continue to watch the progress both as an interested spectator and a life insurance professional. My goal in following this program has never been to be actively involved in it’s progress, but rather to use the real life examples of the weight loss to illustrate that overweight and obesity do not have to stand in the way of getting life insurance. Further I wanted all to know that it may not take a huge change in weight to make a huge change in life insurance rates.
Will was voted off last night. Will hit the wall and couldn’t work through it and the other participants decided that he was hurting their chances of reaching their own goals. While I understand the team aspect of the program, in real life, you pick your team and you pick a team that will offer you the best chance of success in regards to your own goals. You surround yourself with people whose goals are common, part and parcel, of your own, not money.
Whether it is weight loss, diabetes or cancer, you need to know that your team will be with you through ups and downs and there is no other agenda.
On to the results. Again, based on the best rates I could find for $250,000 of 20 year term insurance, assuming no health issues and also assuming that the weights achieved are kept off for more than a year. First is their starting weight and current weight. Then their beginning life insurance cost, 3rd episode cost and current cost.
1. Michael started at 319 and is now 258. Start $735, 3rd $420, still $420.
2. Chantal started at 250 and is now 221. Start $535, 3rd $421, still $421.
3. Will started at 472 and is now 413. Start uninsurable, 3rd $560, now $500.***
4. Anthony started at 433 and is now 367. Start $560, 3rd $500, now at $441.
5. Sam started at 382 and is now 323. Start $686, 3rd $553, now at $486.
6. Jami Lynn started at 236 and is now 202. Start $430, 3rd $356, now $165.
7. Loralie started at 241 and is now 206. Start $381, 3rd $225, still at $225.
8. Shea started at 289 and is now 255. Start $475, 3rd $410, nowl at $310.
9. Matt started at 389 and is now 336. Start $613, 3rd $525, now at $478.
***final weight
Jami, while not making her goal to break 200 this week, did become the first person to qualify for preferred rates. I understand her frustration when she didn’t reach her goal. No doubt it will come next week and she will no longer be “the 200# woman”.
I think it is important to note why life insurance underwriters seem to be rather heavy handed when dealing with weight, and why the rewards for weight loss can be so significant. From the Center For Disease Control website, the following list of health risks for overweight people was borrowed:
“Overweight and obese individuals are at increased risk for many diseases and health conditions, including the following:
- Hypertension (high blood pressure)
- Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
- Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)
- Type 2 diabetes
- Coronary heart disease
- Stroke
- Gallbladder disease
- Sleep apnea and respiratory problems
- Some cancers (endometrial, breast, and colon)”
These are not health issues to be taken lightly by individuals or life insurance underwriters.
Bottom line. Don’t let your weight get out of control and if it does, seek help. I know there is nothing easy about weight loss, but there isn’t anything easy looking about the list above either.
Don’t go without life insurance just because of your weight. If you can’t afford $250,000, get $100,000. Provide the protection that you can for your family and increase it to the level you really want as your weight comes down.
August 28th, 2007
This is another one of those life insurance underwriting areas where companies are definitely not all in agreement. Time to contact an independent agent who can choose the right company. They can pretty much all agree that if you have high blood pressure that is treated and well controlled, you will get a preferred rate. The change can come when you start adding other health issues.
Many companies take the stance that if you have several health issues, and any of those issues standing alone would end up with a preferred rate class, then even though you have several, you are still preferred. So let’s take the person with high blood pressure. It is well controlled so he gets a preferred rate. What if the same person was treated for cholesterol and it was also well controlled? Most companies would say he is still preferred.
What if his height and weight is in a preferred build chart and not preferred plus? He’s still going to be preferred. So, let’s add a mild allergy induced asthma that is also well controlled with an inhaler. We’re now up to four preferred underwriting issues and he is still preferred….with some companies. Others just wouldn’t be able to stand to look at all of that information and not hit you with a higher rate.
Now, please note that all of the issues are well controlled. If even one of the areas wasn’t controlled well enough for preferred rates, all of the others aren’t going to help. The rate class will end up going to standard plus or standard depending on the one poorly controlled issue.
That’s how most underwriters would view multiple impairments in the preferred category, but what if we are talking about more serious health problems? What if a person has well controlled type 2 diabetes and a few years ago had a one vessel angioplasty after being diagnosed with coronary artery disease?
Given good control and onset after age 50, a person could get better than standard rates with the diabetes alone as long as all other risk factors were good. In the absence of the diabetes, if a person had one instance of slight blockage requiring an angioplasty, we could probably, absent any other risk factors, find a few companies that would underwrite at standard rates with a good stress test to show that they were back in good shape.
But the combination isn’t good. CAD is a collateral and compounding health issue for someone with diabetes. With the combination, a person might expect to be approved at a standard rate plus as much as 2 to 4 tables (each table equals 25% above the standard rate).
Bottom line. Multiple health issues won’t necessarily change your chance of getting good rates unless those health issues are considered to have a compounding mortality experience.
August 13th, 2007
You gotta love technology. Sometimes the medical science types can come up with a test that is so……….so………..all inclusive, that it falls short in the category of providing statistically significant useful information. One such critter is the “Ultrafast CT scan”.
Most of us have heard of CT scans. They have been around for over 20 years and have been very useful in analyzing such things as cancer, the brain and most internal organs. Where it has fallen short is it’s ability to scan anything that moves. In layman’s terms, it takes such a long, slow, detailed picture, that if something is moving it would be blurred. A great example of an organ that cannot be scanned using traditional CT equipment is the heart.
Well now, or at least in the very recent past, along comes the ultrafast CT, which snaps a much quicker picture. Now mind you it still doesn’t take a perfectly clear picture, but they have apparently improved it to the point where it can detect calcification in the veins.
Oh my gosh!!!! Calcification can’t be good. I know what happens to my shower head when it gets mineral buildup, and it’s no fun. Sorry! Didn’t mean to alarm anyone. Anyway, some heart disease specialists decided that calcification might very well mean coronary artery disease. The problem is it also might just mean that you have some calcification, which by the way, most anyone over age 25 or 30 does have.
So the problem has been to try to guantify and qualify the results of the ultrafast CT so that the scan can dependably detect those with real heart problems and not freak out those without real problems. This is important. Especially important for those folks running around the country selling a trip through their ultrafast CT machine for $400 a pop. If they start freaking out the wrong people, they’ll have to lower the price to get people to do it.
In their efforts to come up with some kind baseline, there has been something of a dilemna. It seems that what the testers deem as significant calcification does not seem to correlate to a high incidence of coronary artery disease, and what the testers deem as insignificant calcification does not seem to correlate to an absence of heart disease. Keep in mind that this new “non invasive” test was heralded as a way to avoid invasive testing. It appears that, due to the inconclusive results of the test, the only way to really find out what the results mean is to go in and have a look………..INVASION!!!!!
Dr Joseph Mercola kind of summed up one view of this whole thing on his website, www.mercola.com, like this. “Every time a new non-invasive heart test is invented, it is hailed as bringing us one step closer to the day when invasive tests will no longer be necessary. And yet, as time goes by and the new non-invasive test comes into common use, more and more invasive tests end up being performed. This is not a mysterious or inexplicable result. It is entirely predictable.
And that’s the Dirty Little Secret. To wit: every new non-invasive test creates a brand new category of “false positive” results that need to be followed up by performing an invasive test. Therefore, each time a new non-invasive test comes into use, the need to perform invasive procedures increases.
For Ultrafast CT scans, this truism applies in spades, because, as we have seen, a cutoff calcium score has been selected that guarantees a significant proportion of falsely positive tests.
So cardiologists lucky enough to work in hospitals that were “early adopters” of Ultrafast CT scanners, and that advertised them sufficiently, found that their catheterization volume increased significantly. They learned to like the Ultrafast CT scan very much, and found themselves willing to appear in commercials promoting this effective screening tool. Cardiologists in neighboring hospitals, feeling the impact of paying customers being siphoned off by (and being catheterized at) rival institutions, tended to react rather passionately and publicly themselves, but in the opposite direction.
I knew there was a point I wanted to make. As these tests become more readily available, more and more results from them are showing up in medical records where life insurance underwriters are seeing the results. Since underwrirters alway err on the side of caution, they, of course, have a tendency to freak out even though there may be further testing that rules out heart disease.
Just thnk what an underwriter could do with the results of a full body scan!!!
June 5th, 2007
When completing a health interview before receiving a life insurance quote from your independent life insurance agent, you will be asked a family history question. Most companies want to know if any member of your immediate family (defined as mother, father and full siblings) has had an occurrence of heart disease or cancer prior to their age 60. Some companies go a little further and include type 1 diabetes or type 2 diabetes and ask about disease prior to age 70.
If the answer is yes to any of those, your agent will ask about that family member and whether they survived whatever illness occurred prior to that age. If you were keeping score, in general an occurrence of disease before 60 would be one strike and a death prior to 60 would be 2 strikes. With each of those you would normally take a one rate class bump up in your life insurance quotes.
Often argued is the relevance if the person being interviewed is healthy, a non smoker and non drinker, and we are discussing a parent who died of a heart attack at, say, age 55 of a heart attack when they were obese, and drank and smoked like there was no tomorrow. While those risk factors certainly contribute to coronary artery disease, there are certain hereditary factors that can also make a person with a great life style susceptible to the same problem. Bottom line from an underwriting standpoint, while that parent didn’t do themselves any favors with the bad habits, is there any proof that they would not have had the heart attack anyway?
A good independent agent can help you navigate toward the company that will be best for you based on family history. There are companies that don’t look at family history of cancer. There are companies that don’t care about occurrences, only deaths. There are companies that, even though a family member died prior to 60, will throw that out if you are past age 60. There are a few companies that will only bump you one rate class if there has only been one immediate family death prior to 60. Why an independent agent? Folks, you aren’t going to get those options with your local State Farm or Farm Bureau agent. If your agent doesn’t have options you will never know they exist.
In summary, family history will remain a part of life insurance underwriting, so seek an agent who knows how to get you the absolute best rate anyway.
May 15th, 2007
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