Message from Coronary Arteries: "Remain Calm! All is Well!"

"Enron Founder Kenneth Lay Dies at 64"

Upon reading this headline one cannot help but wildly speculate as to the cause of Lay's surprising death. Did he commit suicide? Was his body found in a Washington D.C. park? What on earth happened?

Pastor Steve Wende of First United Methodist Church of Houston, said in a statement that church member Lay died unexpectedly of a "massive coronary."

With this news all the doctors of the world gave out a collective "Oh, now I get it." Why do we understand? The clue is in the pastor's statement that Lay died "unexpectedly."

Unexpectedly? Who are they kidding? Unlike my fellow ScienceBlogger Neurotopia V 2.0, who raised the possibilty of foul play, I believe that Kenneth Lay died as a result of the deadly combination of coronary artery disease and an "acute negative emotional state." This is backed up by research studies such as this one from the U.K.:

We studied 34 male patients an average of 15 months after they had survived a documented ACS. According to an interview conducted within 5 days of hospital admission, 14 men had experienced acute negative emotion in the 2 h before symptom onset, and 20 men had not experienced any negative emotion. Hemodynamic variables and platelet activation were monitored during performance of challenging color-word interference and public speaking tasks and over a 2-h poststress recovery period. The emotion trigger group showed significantly greater increases in monocyte-platelet, leukocyte-platelet, and neutrophil-platelet aggregate responses to stress than the nontrigger group, after adjusting for age, body mass, smoking status, and medication.

In other words, psychological stress can trigger acute platelet aggregation. This ain't good. What about the effects of stress on blood pressure?

The emotion trigger group also showed poststress delayed recovery of systolic pressure and cardiac output compared with the nontrigger group.

The obvious conclusion is that acute emotional stress, especially "negative" emotions, can trigger ACS (acute coronary syndrome). Suppose that Ken Lay was not angry over his recent conviction, but depressed. Could this have an effect on his heart health? According to a just-published study of 295 male and female patients with ACS, depression is also a risk factor:

Acute depressed mood may elicit biological responses that contribute to ACS, including vascular endothelial dysfunction, inflammatory cytokine release and platelet activation. Acute depressed mood may trigger potentially life-threatening cardiac events.

All of this talk about the root cause of Lay's fatal coronary syndrome is speculation, but it cannot be denied that negative emotions and depression can have a deleterious effect on one's health - even to the point of no return.

To all those who must fall today under the shears of the merciless Atropos - Resquiat in pace.

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Have to disagree with you on this one.
I have had lots of downs and outs....I think the people that live through them, know how to roll with the punches.
My two cents.
Do love your blogs though, O.C.

People live through lots of downs and outs. But it doesn't follow that a specific individual will live through a specific down and/or out. (Not every heavy smoker gets heart disease, and not every heart disease victim is a heavy smoker, but if you draw the Venn diagram, there's an intersection of considerable size.)

It wouldn't surprise me if Lay's woes contributed to his early death. As a fellow human, I'm sorry for his family, but Lay would have had considerably fewer woes if he hadn't been (at best) criminally negligent or (at worst) the architect of a spectacularly destructive fraud.

All very sad, really.

You do an excellent job of reminding us that the literature does support the possibility that Lay's sudden death was due to acute stress or depression. I agree that this is the most likely scenario. But, how possible is it to induce the coronary syndrome? I would normally never think about this possibility, but let's remember that this was a man who had education and means and still actively chose to do bad things.

Maybe there should be a follow-up study of those who lost their pensions/savings/livelihood during the Enron mess. Perhaps it should be an ongoing study. I wonder how their depression/anger/feelings of helplessness affected their health.

Hmmm. I remember Lewis Thomas's comment in one of his books. Along with the rest of his graduating class in medicine and many others, he was enrolled in a long-term health study. The gist was, "by the time one of us died of heart disease, five of us had committed suicide." It seems to be an occupational hazard of farmers, not only in North America but especially by the dozen in impoverished and drought-ridden countries. And I just watched a TV program two days ago that threw off the remark, "Every year several hundred Pakistani women commit suicide because they have been raped" (and because they will be jailed for adultery if they speak up unless they have four male witnesses). Isn't that an urgent health issue?