Athletic Heart

Since February is American Heart Month, we thought it was a good time to talk about Underwriting the Athletic Heart. How many times have you heard a client say, "I'm in excellent shape... I'm a runner... I'm a weight lifter..."? So, you submit the application and are surprised to learn that the case is not preferred. How can this happen to a perfectly fit and athletic applicant?

The changes that occur with an athletic heart, which are also referred to as cardiac remodeling, are not felt to be pathologic and so a true athletic heart usually should not be associated with an increased mortality risk.

Endurance training results in dilation of the heart and can cause an increase in the thickness of the heart muscle. This type of training (also called dynamic, isotonic or aerobic training) includes cycling, swimming and long distance running. The pattern of combined dilation and thickening of the heart seen with endurance training is called eccentric hypertrophy.

Strength training (also called static, isometric, anaerobic or power exercise), which includes wrestling and weight lifting, exposes the heart to large increases in blood pressure. This predominantly results in increased wall thickness, known as concentric hypertrophy. Engagement in both endurance and strength training can result in a mixed pattern.

While it can sometimes be difficult to differentiate an athletic heart from pathologic cardiac  conditions, the results of cardiac testing can provide clues. For example, diastolic dysfunction, which is a stiffening of the left ventricle, should not be present on echocardiography in an athletic heart. If there is hypertrophy localized only to the interventricular septum, which is the heart muscle that separates the left ventricle from the right ventricle, one should suspect the presence of hypertrophic cardiomyopathy, a primary disease of heart muscle.

Read the full Underwriting Dialogue from Legal & General America