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October 30, 2003 at 07:00 PM
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The weight of morbidity data suggest coronary artery disease (CAD) will be the Number One covered risk encountered in the exciting new product we call critical illness insurance.
This disease manifests most ominously as a myocardial infarction (abbreviated MI). Most of us simply call it a “heart attack.”
Why is it important to know this? Because growing evidence suggests that critical illness insurance will be an increasingly important product in the insurance marketplace. Therefore, producers need to know about recent developments in coronary disease that will impact placement of CI coverage. This article will address this need.
For most of the 20th century, experts held that elevated cholesterol levels were mainly responsible for inciting CAD. Today, we know that inflammation plays an equivalent role in inducing acute coronary events such as heart attacks.
In some ways, inflammation may the more urgent consideration, as it is associated with what cardiologists call unstable plaque lesions. Stable lesions can cause chest pain when provoked by exertion. Unstable lesions, on the other hand, are prone to rupture, inducing formation of a thrombus, or blood clot, that is the known culprit in most heart attacks.
Researchers have discovered a new marker, performed as a simple blood test, that helps to pinpoint persons having, or at risk of having, an unstable disease. This test is called high sensitivity C-reactive protein, or hs-CRP for short.
Individuals with elevated hs-CRP levels are greatly at increased risk, not only a first event but also for later events, if the person manages to survive the first heart attack.
It is likely that insurers will make use of this inexpensive test in screening applicants thought to be at increased risk for CAD, based on longtime smoking, elevated cholesterol, high blood pressure and diabetes.
There also is intriguing evidence that hs-CRP may be measured using an oral fluid (saliva) test. If this is true, we may be able to assess risk using this client-friendly alternative to blood collection.
A new test has now been anointed by American and European cardiologists as the Number One marker for a heart attack. It is known as a troponin assay. There are such tests and they are designated Troponin T and Troponin L. Both have identical implications.
