Some life insurance applicants have a history of peripheral vascular disease (PVD) or symptoms of that disease. What should the advisor know about this disease, and how should they proceed with placing the case?
Also referred to as arteriosclerosis obliterans, PVD entails build-up or narrowing of the vascular system due to plaque. Peripheral in this case means the legs and arms. Plaque generally consists of calcium and deposits of cholesterol which cause abnormal development of cells on the inside lining of the arteries. PVD makes blood flow through the arteries difficult.
General onset occurs in those over age 50, and the disease is more commonly seen in men than in women. Therefore, as the current baby boomer population ages, experts predict that the amount of people diagnosed with PVD will grow.
The disease is more common among smokers and those with diabetes and coronary artery disease.
The claudication or restrictive blood flow due to PVD’s narrowing of the arteries eventually causes pain, edema (swelling), changes in the outer skin tissue, numbness and even ulceration. Onset does not generally display as immediate. Rather, its existence progresses with symptoms.
However, many people who actually have the disease do not exhibit symptoms. And, among those who do show symptoms, many may feel their symptoms are simply part of the aging process.
When reviewing a risk for life insurance that presents with PVD, keep in mind there are generally 4 classifications of severity, ranging from insignificant, to mild, moderate and severe.
A case with mild PVD may have some complications from strenuous exercise, such as claudication.
When there are severe symptoms, the disease will progress to skin ulcerations. These are difficult to heal, possibly leading to infection. Eventually, this could result in amputation of a limb.
Many factors can complicate PVD. These include elevated lipids, hypertension, diabetes and smoking. Other contributing factors are vascular disease, arthritis, autoimmune disease, injury and phlebitis. There may also be the co-existence of coronary artery disease, renal disease, stroke or atrial fibrillation.
Treatment of PVD can range from a daily aspirin to pentoxifylline and warfarin. It’s also known that a diet high in folic acid and the use of vitamin B12 reduces the risk of the disease.
Aspirin will aid in keeping blood cells and platelets from clumping. Pentoxifyline helps with the flow of red bloods cells, making them more flexible or less sticky and easier to flow past plaque and deposit buildup; it aids with delivery of oxygen needed for tissues, too. Warfarin is an anticoagulant that disrupts the formation of blood clots.
In cases diagnosed as severe or where pulselessness, paralysis and gangrene are evident, treatment can result in a peripheral arterial bypass to relieve blockage and restore blood flow. Claudication restricting blood flow, causing pain and hard-to-heal wounds, may lead to gangrene and possible loss of a limb. With the bypass, veins from the patient or synthetic veins are used to detour the blockage so blood flow can be restored.
Another disease related to PVD includes Raynaud’s Disease. This is a small blood vessel disorder in which an overreaction of stimuli causes a poor flow of blood. It usually occurs in the fingers.
PVD is also associated with abdominal aortic aneurysm, which is the bulging of the abdominal aorta. This occurs when the flow of blood through the blood vessel becomes weakened and therefore causes the vessel to bulge at its weakened point. This can be extremely dangerous if the aneurysm ruptures, thus causing internal bleeding.
When assessing a client with a history of PVD, be sure to do some good preliminary field underwriting.
First, find out age of onset. Surprisingly, the younger this age, the higher the rating. For instance, if onset was before age 40, the rate can be double that of someone diagnosed at, let’s say, age 45.
If there is no history of coronary artery disease, transient ischemic attack (mini-stroke) or stroke, or if findings are in someone who is without symptoms, there may be no rating.
But, complications compounded by diabetes, smoking, elevated lipids or hypertension will add extra debits, especially if the single rating for any of these disorders is other then standard.
Surgical intervention–such as the peripheral vascular bypass–usually does not suggest an extra rating unless complications develop from the surgery.
Doing the field underwriting homework is important. It enables advisors to inform the home office underwriter of key information necessary to make the most aggressive underwriting offer possible for the client.
Elizabeth V. Cammarota is vice president at Brokerage Professionals, Inc., Phoenix, Ariz. Her email is firstname.lastname@example.org.