Atherogenic dyslipidemia--a medical underwriter's iceberg

Life insurance medical underwriters assess cardiovascular risk by applying versions of cholesterol guidelines that were written in the early 1980s, when people were not obese, triglyceride levels were lower, and the low-density lipoprotein particles carried 95% of the cholesterol ester. Today in 2010, 30% of the population is obese, triglyceride levels are higher, HDL-C levels are lower, and LDL-P may carry as little as 60% of the circulating cholesterol ester. Applicants with cardiometabolic risk have an atherogenic dyslipidemia, which is characterized by a normal LDL-C, numerous small LDL-particles, mildly elevated triglycerides, and a depressed level of HDL--and a markedly increased risk of coronary artery disease. New and alternative lipid tests are available to help insurers better underwrite this new risk.