Ken Lay's Heart Attack: A Case of Death By Stress?

The death of Enron founder Ken Lay Monday, reportedly from a heart attack, has raised the question of whether stress can, literally, kill you.

Lay, 64, was at the center of one of the biggest corporate scandals in U.S. history. Convicted in May of 10 counts of conspiracy and fraud, he was due to be sentenced in October and faced 25 to 40 years in prison.

Although Lay's family has not yet released details of his death in Aspen, Colo., or his health history, news reports early Monday quoted Lay's Houston pastor as saying Lay died of a heart attack. Later Monday, doctors who were conducting the autopsey on Lay said Lay's arteries were clogged and reported that they had found evidence of a previous heart attack.

WebMD spoke with cardiologist Robert Myerburg, MD, about the role stress may play in heart attacks. Myerburg is a professor of medicine and physiology in the cardiology division of the University of Miami’s medical school. Myerburg is not familiar with Lay’s medical history.

Job Stress May Raise Heart Disease Risk

Long-Term Stress & Heart Risks

Heart attacks and sudden death have been studied in relation to long-term stress and short-term (acute) stress, Myerburg tells WebMD.

He describes long-term stress as spanning “a number of years,” such as a “stressful job or a stressful environment throughout one’s life.”

Myerburg says “there are some data that says that stress over the long term can… contribute to risk of heart attack and sudden death.”

He notes that long-term stress “may increase the probability” of those problems, “as opposed to being the cause.” In other words, long-term stress may make heart attack or sudden death more likely but probably aren’t the sole cause of such problems.

Rich People Die Differently

Sudden Stress & Heart Problems

Short-term stress unfolds in “minutes to hours,” Myerburg says.

For instance, he notes that when Los Angeles experienced an earthquake in 1994, the L.A. area had three to four times the number of heart attacks and cardiac arrests than would have been expected on any given day.

But over the next two or three weeks, L.A.’s heart attacks and sudden deaths were lower than normal, Myerburg says. The theory, he explains, is that the earthquake caused a spike in heart attacks and sudden deaths among people who were on the verge of those problems.

“One of the biggest challenges is unrecognized heart disease,” Myerburg says. He points out that “in a third of sudden deaths, sudden death is the first clinical manifestation of heart disease.” Those victims had had no previous warning their hearts weren’t healthy.

Career, Health Status May Be Connected

Where Does Lay Fit?

If Lay had had a heart attack or died suddenly upon hearing his verdict, that scenario would have qualified as acute stress. If his legal case had lasted 10 years, that would fit long-term stress, Myerburg says.

But Lay’s death doesn’t quite fit either pattern. “It’s hard to know where to put that,” Myerburg says, calling Lay’s legal ordeal an “intermediate” length of stress.

Enron entered bankruptcy in 2001. And Lay’s criminal case lasted several years, but it was “not long enough to talk about development of heart disease,” and “not long enough to develop atherosclerosis,” Myerburg says.

Atherosclerosis, or hardening of the arteries, is a major heart risk. Doctors don’t know exactly how stress affects atherosclerosis or heart disease.

What Happens During a Heart Attack

Coping With Stress

Getting a thorough checkup can help gauge your heart risk. And since stress is part of life, learning to cope with it may help.

Handling stress can be “rough,” Myerburg says. Acute stresses often can’t be avoided, and long-term ones may be hard to budge.

Myerburg says he often advises people to see psychiatrists or psychologists to help them cope with situational stresses. He calls long-term stress a “quality of life issue.”

The following strategies may help you cope with stress:

--Eat and drink sensibly. Overindulging in alcohol and food adds to stress.

--Assert yourself. Learn to stand up for your rights and beliefs while respecting those of others.

--Stop smoking. Nicotine acts as a stimulant and brings on more stress symptoms.

--Exercise regularly. It’s a stress-buster. Get your doctor’s approval before starting a new fitness program.

--Relax every day. Techniques include meditation, deep breathing, biofeedback, and mental imagery.

--Take responsibility. Control what you can and leave behind what you cannot control.

--Cut causes of stress. Take good care of yourself, don’t overload your schedule, set priorities, and skip hassles, such as bad traffic, when possible.

--Examine your values and live by them. Doing so may make you feel better, even under stress.

--Set realistic goals and expectations. It's OK -- and healthy -- to admit you cannot be 100 percent successful at everything all at once.

--Build your self-esteem. Feeling overwhelmed? Remind yourself of what you do well.

--Get enough rest. The time you spend resting should be long enough to relax your mind as well as your body.

Visit WebMD's Heart Disease Health Center

By Miranda Hitti, reviewed by Louise Chang, MD

SOURCES: Associated Press. Robert Myerburg, MD, professor of medicine and physiology, cardiology division, University of Miami Leonard M. Miller School of Medicine. Reuters. WebMD Medical Reference in collaboration with The Cleveland Clinic: “Stress and Heart Disease.”