Impaired Risk Review...
Robert Goldstone
March 2017

Most of us are programmed to know what our cholesterol levels are, and doctors are constantly cautioning us to watch our cholesterol or to take medication which helps in lowering our blood level.  High cholesterol in addition to such health conditions as heart disease, diabetes, hypertension and vascular disease pose higher risks in overall health and in underwriting.  How about triglyceride levels however?  They are part of virtually every comprehensive medical panel and enter into underwriting and health risk as well.

Triglycerides are one of the fats found in blood.  They are stored in fat cells in the body and are usually the storage for calories the body doesn’t immediately burn.  They are often liberated into the bloodstream at times when there is little or no caloric intake.  Increased triglycerides are associated with atherosclerosis even when total cholesterol may not be elevated.  Elevated triglycerides predispose to heart attack, stroke and cardiovascular disease and also increase the risk of acute pancreatitis.  Poor diets that are high in sugar and carbohydrates generally cause higher levels of triglycerides because they are easy fats hanging around for use when taken in at a higher rate than they can be burned for fuel or energy.  Obesity, insulin resistance, diabetes and alcohol abuse are also causes of high triglycerides.

There are generally no symptoms of high triglycerides, and the diagnosis is made on a blood test.  Because the body instantly starts breaking down sugars and carbohydrates on ingestion, most insurance physicals ask that you fast before the blood is drawn.  Most people have normal triglycerides even after a meal, but this is one part of the blood profile that is influenced by not being taken fasting.  Cholesterol however is generally a more stable number and is more minimally affected.  

Some people are affected by diseases that are genetic and which raise triglycerides well above normal at virtually all times.  Familial hypertriglyceridemia is inherited as an autosomal dominant condition that causes an increase in triglycerides early in life.  Other conditions such as familial lipoprotein lipase deficiency do the same thing.  Most of these cases are diagnosed on a routine blood draw or by family history.  When the condition is inherited, there can be physical signs such as xanthomas (skin eruptions), eye abnormalities (a lipid “ring” can be seen on an eye exam), enlargement of the liver and spleen, and pancreatitis.  They can be quite serious and generally require medical intervention as soon as they are diagnosed.

Medications can cause increased triglyceride levels.  Corticosteroids (like Prednisone for example), estrogens, and beta blockers for hypertension are all known causes.  Certain diuretics, skin products and protease inhibitors can do the same.  Other medical conditions such as hypothyroidism, lupus, and medication for HIV infection are also implicated in high readings.  High triglyceride levels are also quite common in alcohol abuse.

Since high triglycerides are also found with many primary diseases, it is important to identify those coincident risks and be sure they are treated appropriately.  Diabetics whose blood sugars are out of control have high triglycerides.  High cholesterol levels have their significance increased when accompanied by high triglyceride levels.  Elevated levels may contribute to hypertension and the risk of vascular events such as strokes.  And very high levels are strong irritants to the pancreas and can cause  attacks of acute pancreatitis.

The primary therapy for high triglyceride levels (in the absence of any primary conditions that naturally need to be treated in and of themselves) is dietary.  Alcohol avoidance, ingestion of lesser forms of simple sugars, starches and foods high in saturated and trans-fatty acids are immediate goals.  The use of medications such as niacin and omega-3 fatty acid supplements are helpful.  Most all of the statin class of drugs is also successfully used, especially in combination with elevated levels of cholesterol as well.  Normal triglyceride levels are under 150 mg/dl, levels above 200mg/dl start to involve ratable risks and numbers over 500 mg/dl are indications for active medical treatment in addition to dietary modification.  Preferred consideration is more limited to consistently lower triglyceride levels and the absence of other cardiovascular risk factors such as hypertension, diabetes and smoking. 

Author's Bio
Robert Goldstone, MD, FACE, FLMI
MD, FACE, FLMI, board certified internist and endocrinologist, was most recently vice president and chief medical officer for Pacific Life and Pacific Life and An­nu­ity. He has extensive brokerage and life insurance experience, having been medical director at both MetLife Brokerage and Transamerica Occidental Life. Goldstone is board certified in insurance medicine and the inaugural recipient of the W. John Elder Award for Insurance Medicine Journalism Excellence. He was also honored as a fellow of the prestigious American College of Endo­­­crinology and has written monthly for Broker World since 1991. Goldstone does consulting full or part-time as well as on a fill-in basis for companies who need a medical director/physician. He can be reached by ­telephone at 949-943-2310. Emaill:

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