Underwriting Overview: Coronary Artery Disease
Over the last few months, I have been presenting on the topic of coronary artery disease (CAD), which is one of the most common impairments we see today in client risk selection. So it was quite fitting that as we officially kick off the start of summer, I’m pleased to provide this new underwriting overview for CAD – the “kickoff” of the first in a series of impairment guidelines that our Underwriting team has been hard-at-work creating for you.
Just the Facts About CAD
Let’s start with some basic CAD epidemiology facts and data:
- Coronary artery disease is still the nation’s number one cause of mortality with 696,962 deaths in 2020.1
- Age plays a vital role in the deterioration of cardiovascular functionality, resulting in an increased risk of cardiovascular disease (CVD) in older adults and both men and women.
- The American Heart Association (AHA) reports that the incidence of CVD in U.S. men and women is about 40% from ages 40-59, about 75% from 60-79 years, and about 86% in those above age 80.2
Currently, there are numerous diagnostic cardiovascular studies that we encounter in underwriting. CAD is commonly diagnosed based on age, medical history, and many times routine cardiovascular screening tests like the EKG, calcium scoring scans (EBCT), stress tests, echocardiograms, and now cardiac biomarkers, that include NT-proBNP – which we run on many of our insurance blood profiles.
Treatment of coronary artery disease is directed at reducing the risk factors for progression. Conventional risk factors and lifestyle modifications include weight reduction, blood pressure, and lipid controls, exercise, medications, and cessation of tobacco product use. When surgical intervention is required, angioplasty (PTCA) with and without coronary artery stenting, is by far the most common procedure (over two times) versus Coronary Artery Bypass (CABG). After surgical intervention, we require a three-month period before considering life insurance coverage.