The death of Enron Corp. founder Kenneth Lay raises questions about the impact of his recent trial and conviction on his health, but the link between stress and heart disease is not clear-cut, experts said.

Lay, 64, died on Wednesday, six weeks after being found guilty of fraud and conspiracy in one of the biggest corporate scandals in U.S. history.

Dr. Rob Kurtzman, the forensic pathologist who performed an autopsy on Lay’s body, said he died from coronary artery disease and that his examination found signs that Lay had had an earlier heart attack.

The stress of seeing the company he founded fall apart, the strain of a trial and shame of conviction could have set up a 64-year-old man with coronary artery disease for sudden death, doctors agreed.

Or he could have been overdue for a second heart attack anyway.

“People need to understand that heart disease is based on a combination of risk factors that can include your family history, your genetic risk as well as other risk factors,” said Dr. Nieca Goldberg, a spokeswoman for the American Heart Association and a cardiologist at Lenox Hill Hospital in New York.

“We know that stress isn’t good for your health, but in terms of its relationship to heart disease, we don’t know the strength of the link the way we do about cholesterol and high blood pressure and diabetes and smoking,” Goldberg said in a telephone interview.

“It is not unusual when a person has a heart attack, they have it after a sudden life-changing event. It could be loss of a spouse, loss of a house, loss of a job.”

Stress can cause people to eat badly and to avoid exercise - raising the risk of heart disease and stroke.

“Do they just have more stress and the stress causes them to do stuff that is more unhealthy ... or is it the stress directly causing the problem?” asked Dr. Chip Lavie, a cardiologist at the Ochsner Health System in New Orleans.

“The classic is a person who has a big fight with their spouse and then has a heart attack. Now that person has bad artery disease and the fight with the spouse didn’t cause the bad artery disease,” Lavie added in a telephone interview.

Lay had several other risk factors, such as his age.

“Stress does alter some of your risk factors for heart disease,” Goldberg added. “It raises blood pressure. It also makes platelets more likely to clump together ... and blood clots do cause heart attacks. “

Scientific studies of stress and heart disease have been less than conclusive. Just last month a team at Laval University in Quebec found that job strain was linked with heart disease, but only in people in low-status jobs.

British researchers have made similar findings that suggest executives are not as subject to the health effects of stress as are workers who must follow their orders.

Heart disease is the leading cause of death in the United States, killing more than 700,000 people a year. Strokes cause another 170,000 deaths.