Are you one of the 26 Million Americans at risk for heart disease, heart attack or stroke?
Chances are then you are on cholesterol medication, and you’re in good company. There are varying estimates, however, according to the American Heart Association between 20 million and 39 million people are taking it too.
In this article, after talking about cholesterol itself we will explore common cholesterol medications and their effect on life insurance.
This will give you the knowledge you need to apply for the right life insurance policy even if you have high cholesterol.
What is High Cholesterol? How Does it Change Life Insurance?
Cholesterol is a substance naturally produced by your body in the liver, and it is a basic building block of healthy cells. Your body needs cholesterol, but not too much.
Some people naturally make higher levels of cholesterol; in fact, it is a trait that can be inherited. Add in unhealthy lifestyle choices like poor diet and lack of exercise, and that leads to a cholesterol excess.
Diets high in saturated fats and trans fats are unhealthy and cause cholesterol levels to climb. Your cells only use so much, so excess cholesterol is deposited in your arteries.
There are new studies that a Mediterranean diet may be very beneficial to lower your cholesterol levels.
Exercise helps lower cholesterol by helping you lose weight. People carrying extra pounds tend to have higher levels of cholesterol.
Regular exercise also helps to stimulate enzymes that move cholesterol out of the bloodstream to the liver. Once it’s in the liver, the liver will convert it for digestion or get rid of it.
Over time, the cholesterol deposits can build up in your vessels, eventually restricting arterial blood flow. When the flow is reduced, oxygen-rich blood is not getting to your heart or brain, and your risk increases for having a stroke or heart attack.
Types of High Cholesterol Medication
Doctors may prescribe a cholesterol-lowering medication if diet and exercise aren’t reducing cholesterol levels. These medications work to reduce a particular type of cholesterol known as low-density lipoprotein (LDL) or “bad” cholesterol. LDL is termed “bad” because it contributes to the hard plaque deposits that can clog arteries and make them less flexible over time.
LDL-lowering medications fall into several different categories based on how they specifically function.
The most common class of drugs is known as statins. These are very widely prescribed by doctors, and in fact, are typically the first drug a doctor will prescribe for a cholesterol problem. They work to lower not only LDL, but also triglyceride levels, and they work to mildly raise high-density lipoprotein (HDL) or “good cholesterol” levels. HDL is called “good” cholesterol because it helps remove LDL from the arteries.
Widely prescribed statins
- Atorvastatin (Lipitor)
- Rosuvastatin (Crestor)
- Simvastatin (Zocor)
- Pitavastatin (Livalo)
- Pravastatin (Pravachol)
- Fluvastatin (Lescol)
While statins do lower your risk of having a heart attack, they do have many side effects, including muscle inflammation/pain and possible damage, intestinal problems, neurological problems, and in rare cases, memory loss or liver damage.
Statins also interact with many other medication types, sometimes positively, like Fibrates
Fibrates and Statins: a one-two combo
So Fibrates don’t actually lower your LDL levels, however, we still need to talk about them here. They effectively deal with very low-density lipoprotein (VLDL), and they boost levels of high-density lipoprotein (HDL) or “good” cholesterol.
Often times, fibrates will be prescribed in concert with a statin. The only time we see them on their own is if the client has high triglyceride levels but LDL levels are fine. This is rare.
Usually, fibrates are coming to the party with a statin date.
Fenofibrate (known as Antara, Lofibra, Tricor, and Triglide), Gemfibrozil (Lopid), and Clofibrate (Atromid-S) are the examples we see most often.
Statins and Life Insurance Rates
Statins are one of the most prescribed drugs in the world, and they are also one of the most studied drugs in the world.
We see them every day, they are very common on life insurance applications and will have a low impact on your life insurance rates.
As long as they are working, they will not affect your life insurance rates at all.
Intestinal Drugs (Bile Acid Resin Drugs)
Some cholesterol-lowering medications work inside your intestine by attaching to a substance called bile that is produced by your liver. The main component of bile is cholesterol.
The drugs prevent bile from being absorbed back into your blood so that in effect lowers your total cholesterol level.
These drugs are sometimes called bile acid sequestrant drugs or bile acid resin drugs, and examples are:
- Colesevelam (Welchol)
- Colestipol (Colestid)
- Cholestyramine (Prevalite)
A similar drug called Zetia (ezetimibe) works a little differently. It blocks cholesterol (LDL) absorption in the small intestine, and is usually prescribed to people who have already suffered at least one heart attack, and is often prescribed in addition to a statin in these cases.
Because this class of drug works in the intestine, people who take it often have an upset stomach, gas, constipation, or other intestinal problems.
They can also interfere with the absorption of fat-soluble vitamins such as Vitamin K, Vitamin E, Vitamin D and Vitamin A. Your doctor may recommend a vitamin supplement as a result.
Intestinal Drugs and Life Insurance Rates
We see intestinal drugs all of the time and they usually have no effect on your life insurance rates. However, if this is aggressive cholesterol therapy due to your body being unresponsive, underwriters will need to see a history of cholesterol stability.
Go ahead and apply with confidence. You have the green light!
Prescription Niacin to Lower Cholesterol
Niacin is also called nicotinic acid. It is a B-vitamin that is found naturally in certain foods, but people with high cholesterol can take it in prescription high doses. It has the same function as the other described drugs, that is, to lower LDL cholesterol and raise HDL cholesterol.
Niaspan and Nicoar are two examples. Some people feel itching and tingling when taking niacin drugs, called flushing. If this is the case for you, ask your doctor for a time-release dose.
Niacin and Life Insurance Rates
So since Niacin is just a vitamin it should be no problem, right? The answer is . . . maybe.
Since you will need to take blood and urine samples with a life insurance paramedical exam, Niacin might negatively affect your liver enzymes.
Most of the prescription doses are in the 1 gram to 3 gram range, and 500 mg has been shown to raise liver enzymes enough they could affect a blood test.
This affects 25% of the population or so. If you are taking Nicoar or Niaspan, you should note it with your life insurance underwriting expert.
As an alternative, explore the life insurance policies that are available without a medical exam to avoid the blood test altogether.
The New Kid in Town: PCSK9 Inhibitors
These medications are the newest cholesterol-lowering drugs, and they work by blocking a specific protein (called PCSK9). When this protein is not present, your body has an easier time removing LDL from your bloodstream.
These drugs are typically prescribed only to people who have extremely high genetic cholesterol levels resulting from an inherited condition. Doctors will also sometimes prescribe them to people who have severe heart disease and have had no results trying one or more statin drugs.
There are two main medications called Alirocumab (Praluent) and Evolocumab (Repatha).
PCSK9 Inhibitors and Life Insurance Rates
Currently, these drugs are EXPENSIVE. According to the NIH, costs are $14,000 – $15,000 per year for Repatha and Praluent. Not cheap.
To a life insurance underwriter, Repatha and Praluent are untested. There just isn’t enough data yet on PCSK9 inhibitors and how they reduce the risk of major cardiovascular events. Therefore, PCSK9 inhibitors are a class of drug that will concern life insurance underwriters somewhat.
There will be more and more research in the future about these drugs and their effectiveness. So this will change.
We don’t see these drugs often on an application due to their cost and limited availability, however, if you’re on PCSK9 therapy it could negatively affect your life insurance rates.
Mother Ocean – Omega-3 Fatty Acid Ethyl Esters
These triglyceride-lowering medications are made from purified and chemically altered fish oils to derive the omega 3 nutrients.
They are typically prescribed for patients with extremely high triglyceride levels, usually over 500 mg/dL and they are thought to work by decreasing the number of triglycerides the body makes.
They can severely interact with other medications, and people who have fish allergies cannot take them due to the likelihood of a severe adverse reaction.
The US Food and Drug Administration (FDA) has approved both Lovaza and Vascepa for use, and currently, they account for over $2 Billion in sales in the United States annually.
Omega-3 Fatty Acid Ethyl Esters and Life Insurance Rates
This class of medication, though derived from plain-old fish oil, is only prescribed in cases of really high triglycerides. That means non-drug options are not working like changing your diet or exercising more, controlling your blood sugar or lowering your alcohol intake.
So either the lifestyle changes are not effective, or you are not following the doctor’s orders. Either way, Lovaza or Vascepa alone will not hurt life insurance approval. However, the other risk factors they are treating will increase your life insurance rates and that’s why the get the yellow light.
The Best Way to get Life Insurance on Cholesterol Medication
Last time we counted, there are over 1400 life insurance companies in the United States. Out of those, only 5% will give you their top health classes and best rates for high cholesterol controlled by medication.
Do you know which companies will give you those top rates? Are you sure?
Don’t make a mistake that could cost you thousands of dollars. Working with an independent underwriting expert who knows everything about life insurance with high cholesterol is your best bet.
The advice is free, and they will steer you to the right company for your specific medication.