Lay's Death Viewed as Cautionary Tale of Catastrophic Stress

ASPEN, Colo., July 5 - Cardiologists suggested that the sudden death here of Enron founder Kenneth Lay is a textbook example of catastrophic stress that can increase the risk of cardiac events.

The 64-year-old Lay, died early today at Aspen Valley Hospital. He was awaiting sentencing in October after conviction of fraud and conspiracy charges that could have put him in federal prison for life.

According to news reports, Pitkin County sheriff's deputies and an ambulance were called to Lay's vacation home around 1 a.m. and transported him to the hospital where he was pronounced dead at around 3 a.m. local time.

A spokesperson for the county said a coroner's autopsy is pending, and no further information would be issued until results are available later this week.

Kelly Kimberly, a spokesperson for the Lay family, announced the death and said there would no additional comments until all members of the Lay family had been informed.

Initial news reports described the death as a "massive coronary", a vague term that doesn't match any accepted clinical diagnosis said Douglas Zipes, M.D., director of the division of cardiology at the Krannert Institute of Cardiology of the Indiana University School of Medicine in Indianapolis.

Dr. Zipes, who is a former president of the American College of Cardiology (ACC), said the recent events of Lay's life suggest an almost textbook setup for sudden cardiac death, which is the initial diagnosis from the ACC.

Extreme stress is recognized as a risk factor for chest pain, rapid heart beat, and sudden cardiac death, he said. He said "catastrophic events over which one has no control such as loss of job, loss of spouse, loss of house, and-in this case-a felony conviction," are all examples of extreme stress that can trigger an episode of ventricular fibrillation and sudden death.

"We know that sudden cardiac death increased following the events of [Sept. 11, 2001 attacks]," Dr. Zipes said. "We know that sudden cardiac death increased following the earthquake in San Francisco [Oct. 17, 1989]."

Lay's death, Dr. Zipes said, reinforces the importance of timely cardiopulmonary resuscitation and the use of automated external defibrillators.

Lay was the founder of Enron, the Houston-based energy-trading company that rapidly expanded during the 1990s and then imploded in an accounting scandal that culminated in his trial and conviction in May of 10 counts of fraud and conspiracy linked to Enron collapse.

Lay, who was tried and convicted with former Enron CEO Jeff Skilling, was awaiting sentencing, which was scheduled for October. Barring appeal, Lay was expected to serve at least 15 years in jail.

Adding to that stress, the Washington Post reported that federal prosecutors were seeking to force Lay and Skilling to turn over .2 million in assets. In a motion filed Friday, the prosecutors asked a judge to order the turnover of assets that the prosecutors said where acquired by fraud.

Marc Penn, M.D., director of the heart-brain institute at the Cleveland Clinic Foundation, said that while catastrophic stress does increase risk of sudden cardiac death, "it also increases the risk of plaque rupture and artery closure."

The final diagnosis awaits autopsy, but he said one take home message from Lay's death is that stress from life events should be taken into account when assessing first events if "for no other reason that the damage from a heart weakened by the neural hormonal response to stress is largely reversible."

Such a finding has "a huge impact on prognosis and there are indications that it stress-induced injury may indicate that certain medications may be a better choice than other drugs," Dr. Penn said. For example, beta-blockers "block neural response and may be a better choice for initial therapy than other medications."

Another factor that may play into cause of Lay's death is depression, Dr. Penn said. He noted that recent published studies suggested that depression following coronary artery bypass surgery increased the risk of acute MI.