LVH: consequences associated with cardiac remodeling

With increased hemodynamic stress, the heart must adjust to meet the greater demands placed upon it. This adjustment frequently involves an alteration or remodeling in its structure or geometry, which augments its performance and helps to maintain adequate function under changing conditions. One of the most important forms of remodeling that the heart may undergo is an increase in muscle mass in response to a pressure or volume overload or myocardial injury. This increase in muscle mass is known as left ventricular hypertrophy (LVH). LVH is of great importance from a risk selection perspective for two reasons: it is common, and it is associated with a significant increase in both morbidity and mortality risk. Thus, it is critical that both underwriters and medical directors be aware of this form of remodeling, its causes, diagnosis and consequences.     

Alcohol abuse and liver enzymes (AALE): results of an intercompany study of mortality

Evaluation of applicants for life insurance who have elevations of their liver function tests or an increased probability of alcohol abuse has always been difficult for underwriters. This paper reports the results of an intercompany study in which the pooled mortality experience of a group of insureds with evidence of alcohol abuse, an adverse driving record or elevations of the liver transaminases or gamma-glutamyl transferase is summarized.     

Matters of the athletic heart

Frequently an underwriter or medical director will question whether an increase in left ventricular mass represents pathologic left ventricular hypertrophy (LVH) or physiologic changes related to exercise. The LVH condition reflects end-organ damage related to abnormal hemodynamic stresses and confers an increased morbidity and mortality risk. When left ventricular mass is increased because of exercise, measured changes represent a normal, healthy cardiovascular system responding to the demands of that exercise. This article summarizes medical findings that distinguish pathologic LVH from an "athletic heart."     

Non-Hodgkin's lymphoma: in a class all its own

Non-Hodgkin's lymphoma (NHL) incidence rates have increased more than 50% over the past 15 years, making it the sixth leading cause of death from cancer in the United States and the fourth most significant malignancy in terms of economic impact. Comparable trends are noted worldwide. Improved diagnostic techniques have resulted in reclassifying some tumors that in the past would have been classified as Hodgkin's disease. In this article, the latest diagnostic, prognostic, and treatment options for NHL are reviewed and a cross-reference chart for these evolving class systems provided.     

Liver function tests: what is the risk?

Five laboratory assays are commonly called liver function tests (LFTs), although these tests are neither specific to the liver nor true measures of liver function. As a result, alanine aminotransferase (ALT or SGPT), aspartate aminotransferase (AST or SGOT), gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP) and bilirubin have proven problematic for clinicians and risk selection professionals alike. Further, underwriters and insurance medical directors find these tests difficult to assess because of the lack of data directly relating LFT elevations to mortality outcome. Nonetheless, the tests are frequently encountered, so a strategy for evaluating abnormal results is critical to ensure accurate and fair pricing. This paper reviews basic information on LFTs, available mortality data and the application of this knowledge to the underwriting process.     

High incidence of nasopharyngeal carcinoma in Asia

Although nasopharyngeal carcinoma (NPC) is a rare cancer in the United States, it is a leading cause of death in other countries. Dr Titcomb reviews several facts about NPC that can be helpful to underwriters as they encounter this tumor in applicants who reside in, or who are a native of, an area of high incidence.