Cardiovascular events, most notably heart attacks, are one of the main causes of critical illness insurance claims.
To deal effectively with this risk, CI underwriters inevitably take a conservative approach to all cases involving adverse cardiovascular (CV) risk factors.
The traditional approach to life insurance screening for cardiovascular disease has been embraced by CI underwriters. In some cases (blood pressure and blood sugar are good examples) this confers value. But then there also are screening modalities that not only have considerable baggage but that may also be overvalued when compared to more progressive alternatives.
To reduce excessive cost and minimize delays in CI underwriting the industry can take some positive steps right now. One is to rethink the basis for assessing overweight and obesity.
Today, the industry uses build (weight in relation to height). The problem with build is that it does not correlate very well with CV risk.
This risk is driven by the presence of abdominal obesity, which is distinct from peripheral obesity carried in the hips, thighs and buttocks. Abdominal obesity is linked to adverse lipid and glucose metabolism, both of which are powerfully associated with premature cardiac events. Peripheral obesity, on the other hand, is inert. Its only drawback is cosmetic.
By relying on build or its equivalent (and the same can be said of body mass index or BMI), the industry underprices many middle-aged males while at the same time overcharges older-age females. To remedy this inequity while also improving CI risk selection, the industry needs to turn to waist circumference (which could readily be measured on paramedical exams).
It is also time to question the value of the prevailing repertoire of CV tests.
How realistic is it to continue to use screening ECGs and stress tests when the priorities of insurance company senior management are (a) controlling business acquisition costs, (b) speeding up underwriting and (c) being more customer friendly?
Could the industry (finally) do away with these expensive, time-consuming and tedious tests and at the same time actually enhance the protective information CI underwriters would have at hand to assess CV risk?
Yes. One option in this regard is to begin using a small number of high-yield blood tests that can be performed readily in conjunction with a routine blood profile.
Four of them are clearly superior indicators of undiagnosed CV risk and the other is the best test for detecting individuals at high risk for one of the fast-growing forms of cancer.
What are these tests?
1. Hemoglobin A1c. This is already widely used in conjunction with diabetes. New studies have shown this test to be a sensitive marker for onset of the metabolic syndrome, a five-component disorder now considered the No. 1 predictor of heart attacks.
2. NT-proBNP. This may be the best-yet insurance-feasible screening test for CV disease to emerge from cardiology research. Numerous studies published in the last several years have shown that elevated NT-proBNP correlates extremely well with the risk of future heart attacks.
3. Tests for apolipoproteins. These carry lipids such as low density (LDL) and high density (HDL) cholesterol in the bloodstream. Years of ongoing research convincingly has demonstrated that two tests in this area, designated Apo AI and B-100, are far superior to other lipid markers in terms of assessing the risk of future circulatory events.
4. The anti-HCV test. This detects antibodies to the hepatitis C virus. It is currently used as a reflexive test. An unpublished study, undertaken by an insurer and shared with this underwriter, shows that by limiting ourselves to only reflexive testing for hepatitis C, industry underwriters miss more than 50% of cases. If insurers were to screen instead, they would greatly increase the detection of the leading cause of liver cancer.
These tests are all available right now from insurance testing laboratories. By using them, underwriters would enhance detection of undiagnosed high-risk CI applicants. At the same time, they would be free of two costly, cumbersome and, in this context, obsolete 20th century screening tests: the ECG and the treadmill stress test.