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Underwriting Vascular Disease for Life Insurance

Published on January 16, 2018

 

What is Vascular Disease?

The human body has a network of thousands of miles of blood vessels, arteries, and veins that carry fluids throughout the body – this is the vascular system. If laid end-to-end, the vascular system could circle the globe several times. Diseases that affect the vascular system are common and can range from manageable to serious. Insurance companies determine insurability and rating based on the severity of the condition, as well as how the condition is being treated. Finding life insurance for clients with vascular disease, though challenging, is not impossible. In order to better assess your client’s insurability, let’s take a deeper dive into the different types of vascular disease.

Vascular disease is conventionally separated into three areas:

  • Coronary Artery Disease (heart)
  • Cerebrovascular Disease (brain)
  • Peripheral Artery Disease (other than the heart or brain)    

Unfortunately, later in life, and especially beyond the age of 50, nearly everyone is impacted by one or more of these types of vascular diseases to some extent. 

Coronary Artery Disease

The most commonly recognized form of vascular disease is coronary artery disease (CAD). About 25% of the deaths in the USA each year are from some form of heart disease, and CAD accounts for more than half of that 25%. CAD involves the major and minor arterial vessels of the heart and inflammation, blockage, or spasm of these vessels. Inflammation of coronary vessels is closely related to the buildup of plaques within the passageways and along the walls of vessels. These deposits can cause inflammation, increased blood pressure, and stretching of the arterial walls which is often a precursor to cardiovascular events like ruptures and myocardial infarction (heart attack).

Cerebrovascular Disease

Cerebrovascular disease involves blood vessels in the brain. Again, key concerns are blockages and ruptures. Significant constrictions of blood flow lead to ischemia (a deficiency of blood flow to the cells), and consequently oxygen-deprived, dysfunctional brain cells. Prolonged periods of ischemia lead to cellular death, and mild ischemia might lead to something called a “transient ischemic attack” (TIA). This is a “mini” stroke, of short duration, with essentially full recovery within 24 hours, and usually without any brain injury or residual neurological symptoms.

A more severe stroke is called a “cerebrovascular accident” (CVA), which is usually caused by either blockages and/or vascular hemorrhage (bleeding). A hemorrhage occurs as a result of the rupture of one or more intracranial vessels, and subsequent leakage of blood to surrounding tissues. Conversely, a subarachnoid hemorrhage (SAH) occurs outside of that tissue (but still within the skull), with leakage flowing to the subarachnoid area of the brain. CVA’s can potentially lead to long-term or permanent neurological dysfunction that might occur virtually anywhere within the body. The variations of such dysfunction are many, but some more common stroke results include varying degrees of paralysis, balance problems, spasticity, speech difficulties, and volatile moods. Strokes are currently the fifth leading cause of death in the USA, accounting for about 5% of deaths each year.  Men are more likely to suffer strokes, but women are much more likely to die from them.   

Peripheral Artery Disease



The third major type of vascular disease is called peripheral vascular disease (PVD) or peripheral arterial disease (PAD). This essentially involves blood vessels extending beyond the heart and continuing to any of the lower or upper extremities (other than the brain). The primary PAD symptom is pain, arising from oxygen-deficient muscle cells and tissues. A very common type of symptom is leg pain when walking (known as intermittent claudication), which resolves with rest. While pain is usually more prominent with exercise, it can also be manifested at rest with severe ischemia.  Severe ischemia can ultimately lead to ischemic ulcers, and eventually gangrene which usually requires amputation. PAD is exacerbated by risk factors such as smoking, diabetes, dyslipidemia, and hypertension. 

How is Vascular Disease Rated?

In general, Standard might be a possible risk assessment for single-vessel CAD at older ages (often beyond the age of 50), for a single TIA at 1-3 years after the event, or for very mild PAD. Moderate vascular disease of any type is often Substandard, and severe vascular disease is often Declined. 

If your client has Vascular Disease, the following information would be helpful in determining eligibility and rating:

  • If there is a medical history of vascular disease, is there some aggregate combination of heart, brain, and peripheral disease?  
  • Age of diagnosis?
  • Is there a family history of myocardial infarction resulting in a death?
  • If there is a medical history of heart disease, is there a history of CAD?
  • If there is a medical history of CAD, is there a history of ischemia, infarction, or spasms?
  • If there is a medical history of brain disease, is there a history of TIA, CVA, or SAH?
  • If there is a medical history of PAD, is there a history of intermittent claudication, ulcers, or gangrene?
  • Is the condition being treated, and if so, how?

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