Underwriting CAD risk requires detailed analysis of the extent of the disease. Disease severity is assessed by multiple factors including:
Plaque burden by catheterization
Number of events and stability
Systolic LV function
Diastolic LV function
Exercise tolerance
Current symptoms or abnormal stress testing (with or without scan/echo)
Other vascular disease
For example:
56 year old non-smoking man has a history of an acute myocardial infarction (Ml), followed by a cardiac catheterization,
showing one vessel disease of 95% in LAD that was stented. He fully recovered with good heart function (LV normal
ejection fraction) and negative stress test with favorable METS. He takes aspirin, beta blocker and has normal lipids on
a statin drug. This applicant could be rated Non-smoker Plus.
56 year old non-smoking man has a history of an acute Ml, followed by a cardiac catheterization showing 3 vessel disease with 95% LAD lesion, 70% in RCA, and 50% Cx. He is recovered after the stents in LAD and RCA, with good heart function (normal LV ejection fraction) and had a negative stress test with favorable METS. He is takes aspirin, beta blocker and has normal lipids on a statin drug. This applicant could be rated Table C.
Life Insurance Solutions, in summary when underwriting a coronary artery disease history, suggests the following factors are very important in assessing the risk:
- age when CAD was diagnosed
- type of event? Heart attack? Angina? Coronary artery aneurysm? Ischemic cardiomyopathy?
- dates of events?
- how many vessels are involved?
- was surgery done?
- coronary bypass graft (CABG)? How many grafts?
- angioplasty (PTCA) with stent?
- what medications are being taken?
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