Blood might be thicker than water,  but chemically it looks pretty much like an ocean puddle.  Cholesterol, like most oils, doesn’t mix well with water, and therefore needs some help traveling through the blood stream.  LDL (low density lipoprotein) is a fatty, messy chemical that tends to spread into a sticky paste as it moves through the blood.  As it flows through the bloodstream, it can catch on and stick to blood vessel walls.  Once a deposit starts , it tends to attract and hold additional material and build up into thick coatings or plaques in the blood vessels.  Nasty, high risk stuff.  HDL (high density lipoprotein) behaves differently.  HDL forms into self contained clumps  that move easily through the bloodstream  until they eventually arrive in the liver where they are filtered out and removed from the body.  Even better,  because oily molecules attract each other,  the HDL moving through the bloodstream tends to grab onto some of the LDL floating by , taking it along to the liver to be cleared from the system.

The clumping, cleansing capabilities of HDL vs. the sticky, pasty nature of LDL give rise to the imagery of “Good Cholesterol” versus “Bad Cholesterol”.    Whether cholesterol presents a health risk in a particular body, or even in a specific blood vessel is a product of a number of a factors.  The health risk is not only a factor of how much cholesterol is circulating in the blood stream, but also of the ratio between the good cleansing cholesterol and the bad pasty cholesterol.  The structure of the blood vessel itself can also play a major role.   A healthy, smooth and clean blood vessel is at lower risk than a vessel weakened by  foreign gunk, obstructions, scratches, scars and plaque lining its walls.

When life insurance companies are rating a health risk, and have the look at risks from elevated cholesterol, they consider both absolute cholesterol levels and the ratio between bad an good cholesterol.   Given a specific amount of cholesterol in your bloodstream,  the underlying risk it presents is determined by  the ratio of Total Cholesterol to HDL.  A very low ratio can halve the risk, while a high ratio can triple the risk. The higher the risk, the higher the life insurance insurance premiums.

Cholesterol ratios run from around 1 to 12.    The higher the number the richer your blood is in the bad stuff.  An average ratio is  3.6 times as much bad cholesterol as good cholesterol.  If that ratio rises to 6 the risk doubles, and at 8 the risk is triple.  A man with an even split of HDL and LDL actually reduces his risk of coronary artherosclerosis and serious heart disease by half.

But HDL levels aren’t just neutral.   HDL levels have an inverse relationship with coronary heart disease .  The ability of HDL to predict the development of coronary atherosclerosis has been estimated to be four times greater than the predictive power of  your LDL levels and eight times greater than Total Cholesterol.  So you will see that most life insurance carriers adjust their ratings based on the cholesterol ratio rather than on the underlying Total Cholesterol.  For most patients, treatment is recommended for those with a HDL level below 40 mg/dL while an HDL level  of 60 mg/dL is considered protection against heart disease.

Since successful cholesterol treatment removes the plaque forming gunk from the bloodstream, it is generally very successful in preventing life threatening damage from occurring.  Therefore, most insurance companies will treat well treated cholesterol as if it wasn’t a factor.

Here is a sampling of how some life insurance carriers look at Cholesterol

TransAmerica:

An overall cholesterol level of 230 with a ratio of 5.0 can generally get you a preferred plus health class from a carrier, while a 300 level and a ratio of 6.0 would put you in a standard class.

Banner Life Insurance Company

As long as your overall cholesterol is between 120 to 300, Banner determines your health class based on the ratio.   4.5  is preferred plus, 5 is preferred and standard is 8.

Genworth’s Life and Annuity Company

Genworth sets its range at 150 to 300, and then looks at the ratio to determine health class.  Its health classification differentiates between men and women.  For preferred plus health class men need to below 4.5 and women below 4.0.  In standard health class you could go as high as 7.5 or 7.0 depending on your gender.

Prudential Life Insurance Company

Prudential Life Insurance is a little bit more generous on cholesterol issues.  Preferred Plus is available up to a ratio of 5, Preferred is 6 and a ratio of 7 can still get you standard plus.

MetLife

Metlife differentiates based on the aged of the life insurance applicant. They are more forgiving for younger applicants, and they don’t differentiate between treated and untreated in underwriting their life insurance policies for cholesterol risk.

To qualify for Preferred Plus:

Age 54 & under – 220 or less and Ratio 5.0 or less,  Age 55 & over – 240 or less and Ratio 5.0 or less OR 260 or less an Ratio 4.5 or less.

To qualify for standard, the Metlife criteria are especially generous.

Ages 0 to 65 – 350 or less and Ratio 8.0 or less, Ages 66 & older – 350 or less and Ratio 9.6 or less