Professional male bodybuilders face more than five times the risk of sudden cardiac death compared to amateur athletes.
Cardiac abnormalities and anabolic substance abuse were commonly found in autopsies of deceased bodybuilders.
Experts urge cultural, clinical, and policy reforms to address rising health risks in the bodybuilding community.
A landmark study published today in the European Heart Journal reveals that sudden cardiac death (SCD) accounts for a significant proportion of fatalities among male bodybuilders, with the highest risk observed in professionals.
The findings spotlight the long-overlooked health consequences of competitive bodybuilding and urge the need for preventive strategies, medical oversight, and cultural reform within the sport.
Led by Dr. Marco Vecchiato of the University of Padova, Italy, the study is the first to quantify the incidence of death and sudden cardiac death in this population.
The researchers analyzed records of 20,286 male bodybuilders who competed in International Fitness and Bodybuilding Federation events between 2005 and 2020. Cross-referencing media, social media, forums, and official sources, they verified 121 deaths, with the average age at death being just 45 years.
Of those, 38% were sudden cardiac deaths. Professionals faced a more than fivefold increase in SCD risk compared to amateurs. Autopsy data, though limited, frequently showed enlarged or thickened hearts, coronary artery disease, and evidence of anabolic steroid use.
Intense practices, real consequences
Dr. Vecchiato explained that while bodybuilding can promote fitness and discipline, it often includes high-risk practices:
Extreme strength training
Rapid weight cutting through dehydration and calorie restriction
Use of performance-enhancing drugs (PEDs)
These routines, especially when prolonged and intensified at the professional level, strain the cardiovascular system and may alter heart structure, increasing susceptibility to fatal arrhythmias and other complications.
“The pursuit of extreme body transformation at any cost can carry significant health risks, particularly for the heart,” Vecchiato warned.
Mental strain and sudden trauma
The study also identified a notable proportion of traumatic deaths (15%), including car accidents, suicides, murders, and overdoses. These suggest a psychological toll associated with bodybuilding culture, potentially exacerbated by substance abuse and pressure to maintain extreme physiques.
Vecchiato noted that these findings “underline the need to address the psychological impact of bodybuilding,” advocating for mental health resources alongside physical health interventions.
Action needed
The study concludes with a call to action for multiple stakeholders:
Clinicians should implement cardiovascular screening and offer preventive counseling for even young, seemingly healthy athletes.
Sports organizations and policy makers should promote education on PED risks, implement stricter anti-doping enforcement, and develop health surveillance programs.
The bodybuilding community must move toward a culture that values safe, sustainable fitness over extreme aesthetic goals.
“Our findings challenge the idea that appearance alone is an indicator of health,” Vecchiato said, stressing that sculpted bodies may conceal serious cardiovascular risks.