The Cardiac Diagnosis

Imdur (Isosorbide Mononitrate) is a long-acting nitrate prescribed to prevent and manage angina (chest pain) in people with coronary artery disease. Imdur use indicates you have been diagnosed with coronary atherosclerosis or another form of significant heart disease resulting in angina symptoms. This is a serious, chronic cardiac condition. Unlike some other conditions, coronary artery disease is progressive and carries a meaningful risk for heart attack, sudden worsening, or complications if not carefully managed. Life insurance companies view cardiac disease more cautiously than non-cardiac conditions. Underwriters evaluate not just current medication use, but your overall cardiac status, disease severity, symptom frequency, and risk of future cardiac events.

“Imdur users have a documented cardiac condition. This is not minor. Insurers approach cardiac disease with rigorous underwriting because heart disease has real implications for mortality and morbidity. Approval is possible, but it requires good cardiac control, current testing, and a clear picture of your disease stability. We don’t sugarcoat cardiac disease—but we also know stable angina can be managed, and many applicants get approved.”

InsuranceBrokers USA – Management Team

Key Underwriting Factors

1. Cardiac Event History

Have you had a prior heart attack (myocardial infarction)? When did it occur? Underwriters view recent cardiac events (within 2 years) very cautiously. Approval becomes significantly harder. Events further in the past (3+ years) with good recovery are more favorable. If you’ve never had a heart attack, approval odds improve substantially.

2. Type and Severity of Angina

Is your angina stable (predictable, provoked by exertion) or unstable (unpredictable, occurring at rest)? Stable angina is more favorable. Unstable angina or recently diagnosed angina raises concerns. Frequency matters: daily angina episodes requiring frequent medication are more concerning than occasional episodes.

3. Ejection Fraction and Left Ventricular Function

This is critical. An ejection fraction (EF) above 50% is normal and favorable for underwriting. EF 40-50% is reduced but still insurable with rate adjustments. EF below 40% indicates heart failure and significantly complicates approval. Underwriters will absolutely request recent echocardiogram results.

4. Recent Stress Testing or Cardiac Catheterization

Recent stress test results showing mild to moderate disease with no severe ischemia are favorable. Stress tests performed in the past year are preferred. Cardiac catheterization results showing the exact extent of coronary stenosis (narrowing) help underwriters assess severity more precisely. Without recent testing, approval becomes uncertain.

5. Other Cardiac Risk Factors

Do you have diabetes, hypertension, elevated cholesterol, or a history of smoking? These are compound cardiac risks. Underwriters evaluate your entire cardiac risk profile. Controlled diabetes and blood pressure are better than uncontrolled. If you’re still smoking, expect higher rates or a possible decline.

6. Current Medication Compliance and Symptom Control

Are you compliant with Imdur and other cardiac medications (beta blockers, aspirin, statins)? Is your angina controlled, or are you experiencing frequent breakthrough symptoms? Good medication compliance and symptom control are favorable. Poor control or medication non-compliance raises red flags.

Underwriters will request:

• Most recent echocardiogram (echo) report with ejection fraction
• Recent stress test results (nuclear stress test, exercise stress test, or dobutamine stress test)
• Cardiac catheterization report if ever performed (showing coronary anatomy and stenosis locations)
• Cardiology office notes from most recent visit (within 6 months ideally)
• EKG from recent visit showing current rhythm and any prior changes
• Complete medication list with current dosages
• Any hospital records if you’ve had cardiac events or interventions (bypass surgery, stent placement, etc.)
• Lipid panel results (cholesterol, triglycerides)

Why Recent Testing Matters

Underwriters want testing from within the past year if possible. Old testing (3+ years ago) raises questions: Has your disease progressed? Have you had unreported cardiac events? Current testing shows your disease status right now. If your most recent echocardiogram is from 3 years ago, consider getting an updated echo before applying—it often improves approval odds significantly.

Best-Case Scenario (Most Likely Approval)

• Diagnosis timing: Angina diagnosed 2+ years ago, stable and not worsening
• Cardiac events: No prior heart attack or hospitalization for cardiac reasons
• Angina pattern: Stable, predictable angina; infrequent episodes (1-2x per week or less)
• Ejection fraction: ≥50% (normal function)
• Recent testing: Stress test or cath within the past 12 months showing mild to moderate disease
• Other risk factors: Well-controlled blood pressure and cholesterol; not currently smoking
• Medication compliance: Demonstrably compliant with Imdur and other cardiac medications

Moderate-Risk Scenario (Approval Possible, Higher Rates)

• Cardiac event: Prior heart attack, but 3+ years ago with good recovery and no recurrence
• Angina pattern: More frequent episodes (3-5x per week) but responsive to medication
• Ejection fraction: 40-50% (mildly reduced)
• Other risk factors: Diabetes or hypertension present but reasonably controlled
• Testing: Recent stress test showing moderate ischemia but no severe findings

High-Risk Scenario (Approval Difficult or Unlikely)

• Recent cardiac event: Heart attack within the past 2 years
• Unstable or worsening angina: Frequent episodes (daily), occurring at rest, or a recently changed pattern
• Low ejection fraction: <40% (heart failure)
• Multiple cardiac interventions: Prior bypass surgery or multiple stent placements
• Poor control: Frequent hospitalizations or ER visits for angina; medication non-compliance
• Additional complications: poorly controlled diabetes, active smoking, significant arrhythmias

Typical Rate Ranges (Term Life Insurance, $500k benefit)

Best-case (stable angina, EF >50%, no prior MI): Standard to 30% above standard

Example: A Standard male aged 55 might pay $45/month. With stable angina: $55-60/month

Moderate-risk (prior MI 3+ years ago, EF 40-50%): 50-100% above standard

Example: Same applicant with moderate-risk profile: $70-90/month

High-risk (recent MI, unstable angina, low EF, frequent hospitalizations): Possible decline or very high rates (100-200%+ above standard)

Many high-risk applicants are declined by standard carriers. Some may qualify through high-risk or guaranteed issue carriers at substantially higher cost.

Important Note on Pricing

These ranges are estimates based on typical underwriting. Your actual rates depend on your specific age, gender, overall health, other risk factors, and the insurance company’s underwriting guidelines. Rates also vary significantly between carriers. Getting quotes from multiple companies is essential—some carriers are more favorable to cardiac applicants than others. A broker who works with carriers experienced in cardiac underwriting can significantly impact your options and pricing.

Pre-Application Preparation (Best Practice)

1. Update Your Cardiac Testing

If your last echocardiogram or stress test is more than 12 months old, schedule an update before applying. Fresh testing often dramatically improves approval odds and rates. This is especially true if recent years have been stable—newer testing can prove that.

2. Optimize Your Cardiac Risk Factors

If you’re still smoking, quit at least 12 months before applying (underwriters view non-smoker status much more favorably). Get your blood pressure and cholesterol into optimal ranges. If you have diabetes, focus on tight glucose control. These improvements take time but can meaningfully improve rates.

3. Gather Complete Documentation Before Applying

Don’t wait for the insurance company to request records. Proactively compile echocardiogram reports, stress test results, catheterization records, recent cardiology notes, and EKG reports. Provide these upfront with your application. This shows organization, transparency, and speeds up underwriting dramatically.

4. Be Completely Honest About Your History

Do not omit cardiac events or hospitalizations from your application. Underwriters will discover everything through medical records anyway. Omissions are treated as fraud and result in denial or policy cancellation. Full disclosure protects you and your coverage.

5. Work With a Broker Experienced in Cardiac Underwriting

Not all insurance companies are equally favorable to cardiac applicants. Some carriers specialize in cardiac disease and have more lenient underwriting. A broker familiar with each carrier’s cardiac guidelines can direct your application to the most likely approver. This can mean the difference between approval and decline, or standard rates versus heavily rated.

During the Application

Expect and answer detailed questions about:

• When your angina began, and what triggered the diagnosis
• Frequency and severity of angina episodes
• Any cardiac events (heart attacks, arrhythmias, hospitalizations)
• Any cardiac procedures (stents, bypass surgery, etc.)
• Your cardiologist’s name and when you last saw them
• All cardiac medications you take and your compliance with them
• Your exercise tolerance and current activity level

Answer every question completely and truthfully. Vague or evasive answers raise red flags.

Can I get life insurance if I’ve had a heart attack?

Direct answer: Yes, but it depends on how long ago it was and your recovery.

Heart attacks within the past 2 years are problematic; approval is difficult. After 2-3 years, if you’ve recovered well with a good ejection fraction and no recurrent events, approval becomes much more likely. After 5+ years of stability, rates become more reasonable. If you’ve had a heart attack, your cardiac testing is even more critical—underwriters will scrutinize it carefully.

What if my ejection fraction is low?

Direct answer: Lower ejection fraction significantly complicates underwriting. EF below 40% indicates heart failure.

EF 40-50% is manageable; rates are higher, but approval is usually possible. EF below 40% is serious. It indicates heart failure and substantially reduces approval likelihood. Many carriers will decline EF below 35-40%. If your EF is low, work with your cardiologist to optimize it medically before applying. Some patients’ EF improves with better medication management or cardiac rehab.

Will I need cardiac testing during underwriting?

Direct answer: Probably. EKG is standard. Stress test may be ordered if your records are incomplete.

An EKG is typically part of standard underwriting for any cardiac case. If your most recent stress test or echocardiogram is older than 12 months, insurers often order new testing. This delays underwriting by 1-2 weeks but provides current information. Some insurance companies have paramedics available for in-home EKG and blood work, which speeds the process.

How often does my angina need to occur for approval?

Direct answer: Frequency matters. Stable angina occurring 1-2 times per week or less is manageable. Daily angina is concerning.

Angina that’s predictable and infrequent (once a week or less) is favorable. Several times per week is moderate-risk. Daily angina or angina at rest suggests inadequate control and complicates approval significantly. If you’re experiencing frequent angina, discuss with your cardiologist before applying—better medical control improves both your health and insurance approval odds.

What if I recently had a stent or bypass surgery?

Direct answer: Underwriting is more rigorous. Generally, wait 3-6 months after intervention before applying.

Applying immediately after stent placement or bypass surgery is unlikely to succeed. Wait at least 3 months for initial recovery and to demonstrate stability. After 6 months with good recovery and no complications, approval odds improve significantly. Have post-operative stress testing or imaging available to show that your cardiac status has stabilized.

Do I have to disclose Imdur use?

Direct answer: Yes. Always disclose all medications, including Imdur.

Omitting Imdur or your cardiac diagnosis is fraud. Insurance companies verify medications through pharmacy records and medical history anyway. Complete disclosure is essential. Concealing a cardiac diagnosis can result in policy denial or cancellation.

Can I get approved if I smoke?

Direct answer: Possibly, but rates will be extremely high. Strong incentive to quit before applying.

Smoking with a cardiac condition is high-risk. Smoker rates are already 2-3x higher than non-smoker rates. On top of cardiac disease rates, you’re looking at potentially 150-200%+ above standard. If you quit smoking and maintain a non-smoker status for 12 months, rates drop dramatically. Consider quitting as a pre-application strategy.

Will my rates change after I’m approved?

Direct answer: No. Once approved and in force, your premiums are locked in.

Future cardiac events, worsening angina, or changes to your health will not affect your rates or benefits. Your premiums remain fixed for the life of your policy. This is one reason getting approved sooner rather than later is important if you’re uncertain about your cardiac future—lock in coverage at your current health status.