Cardiovascular events are the #1 cause of mortality (and morbidity).
Our traditional screening approach to cardiovascular disease has elements that confer value. But there are also prevalent screening modalities that have considerable expense and delay baggage, and may also be overvalued when compared to more progressive alternatives.
To reduce excessive cost and minimize delays, there are positive steps we can take right now. One of them is to rethink our basis for assessing overweight and obesity.
Today, we use 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 being 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), we underprice many middle-aged males while at the same time overcharging older age females. To remedy this inequity, we need to turn to waist circumference (which could readily be measured on paramedical exams).
It is now time to question the value and present-day appropriateness of our prevailing repertoire of CV tests.
How realistic is it to continue to use screening ECGs and stress tests?
Senior management’s 2006 priorities are (a) controlling business acquisition costs, (b) speeding up underwriting and (c) being more customer-friendly?
Could we (finally) do away with these expensive, time-consuming and tedious tests and…at the same time…actually enhance the pay-off from the protective information underwriters would have at hand assess CV risk?
Yes, we could!
And one option is to begin using a small number of high-yield blood tests that can be readily performed in conjunction with a routine blood profile.
Four in particular are clearly superior indicators of undiagnosed CV risk
What are these tests?
- Hemoglobin A1-c, 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 5-component disorder now considered the #1 predictor of heart attacks.
- NT-proBNP, which may well be the best insurance-feasible screening test for CV disease yet 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.
- Two apolipoproteins, which carry lipids such as low density (LDL) and high density (HDL) cholesterol in the bloodstream. Years of ongoing research has convincingly demonstrated that two of them - designated Apo A-I and B-100 - are far superior to other lipid markers in terms of the assessing the risk of future circulatory events.
These tests are available right now from the insurance testing laboratories.
By using them, we would enhance our detection of undiagnosed high risk applicants, while, at the same time, free ourselves from two costly, cumbersome and obsolete 20th century screening tests: the ECG and the treadmill stress test.
Time marches on.
Shouldn’t we keep pace?