THURSDAY, July 6, 2006 (HealthDay News) -- Although stress undoubtedly contributed to Enron Corp. founder Kenneth Lay's heart-attack death Wednesday, heart disease was the main culprit, according to the initial autopsy report.
"What he'd been going through undoubtedly played a role in his premature death at age 64," said Dr. Redford Williams, director of the Behavioral Medicine Research Center at Duke University Medical Center and co-author of Anger Kills.
However, Williams added, "when people under major current life stresses die suddenly, in virtually all cases there is underlying atherosclerosis."
In Lay's case, stress was no small matter.
The former CEO was facing a lengthy prison term after being convicted in May on fraud and conspiracy charges linked to Enron's 2001 collapse. The scandal had cost investors billions of dollars, and thousands of people their jobs.
But Lay, who was at his vacation home in Aspen, Colo., when he was stricken, also had a little-publicized history of heart problems. He died of "severe coronary-artery disease," a condition characterized by clogged arteries, according to the Mesa County coroner, as reported by the Rocky Mountain News.
And ABC News reported that Lay had already suffered heart attacks, and had portable heart defibrillators in his houses and on his plane. He had been taking statins to lower his cholesterol, and, about five years ago, his doctors inserted a stent, apparently as a preventive measure.
All these medical details of one prominent man's death could help ease the public perception that stress by itself could bring on a fatal heart attack.
But less spectacular stress than what Lay experienced is known to take its toll.
One recent British study found that men with chronic work stress were twice as likely to develop metabolic syndrome as those reporting no work stress. Women with work stress were also more likely to develop the syndrome, but there were only a few of them in the study. Metabolic syndrome is a collection of cardiovascular risk factors such as obesity, high blood pressure and high cholesterol levels.
And new U.S. research has found that job loss doubles the risk of heart attack or stroke for workers in their 50s and 60s. People over 50 who had been laid off were more than twice as likely to suffer a heart attack or stroke during the study period, compared with those who kept their jobs, the researchers found.
Both heart attacks and cardiac arrest have been linked to stress, although there is more documentation on the former, said Dr. Nieca Goldberg, chief of women's cardiac care at Lenox Hill Hospital in New York City.
People who are chronically stressed have higher heart rates and blood pressure, and they also release the hormone cortisol, which has been implicated in depositing fat around the middle of the body. Depression, too, is considered a risk factor for heart disease, possibly because blood platelets are "stickier" in depressed people and more likely to cause blood clots.
Stress can also cause damage before heart disease is present, Williams said. Studies have found that people who exhibited indicators of stress or anger-prone personalities during their college years were more likely to develop heart disease, as well as to die from any cause by the time they reached 50. At that midpoint, 14 percent were dead in the stressed group, compared to only 2 percent to 3 percent in those with lesser levels of stress.
On the other hand, Williams added, "once heart disease is present, you have the situation where stress makes the prognosis even worse than it would have been."
There is a message here for everyone, Goldberg said.
"When it comes to your heart health, not only do we have to evaluate the traditional risk factors, you have to learn a lot more about your family history and doctors really need to address the emotional health of patients," she said.
According to the American Heart Association, more than 71.3 million Americans in 2003 had at least one form of cardiovascular disease. And heart disease is No. 1 killer of Americans.
Find out more about coronary-artery disease at the American Heart Association.