Professional Male Bodybuilders Face Alarming Cardiac Death Risk

The sculpted physiques that define professional bodybuilding may mask a disturbing health reality. A new study reveals that male bodybuilders experience an unusually high rate of sudden cardiac death, with professional competitors facing risks more than five times greater than amateurs.

This first-of-its-kind research, published in the European Heart Journal, tracked over 20,000 male bodybuilders who competed in International Federation of Bodybuilding and Fitness (IFBB) events between 2005 and 2020, uncovering concerning mortality patterns that challenge perceptions about the health status of these athletes.

Hidden Risks Behind Muscular Physiques

During the average 8-year follow-up period, researchers identified 121 deaths among the athletes studied, with sudden cardiac death accounting for 38% of these fatalities. Professional bodybuilders showed dramatically higher risk, with death rates more than seven times higher than their amateur counterparts.

“Our findings show that the risk of death among male bodybuilders is considerably high,” says Dr. Marco Vecchiato from the University of Padova, Italy, who led the study. “Professional athletes had a markedly higher incidence of sudden cardiac death, suggesting that the level of competition might contribute to this increased risk.”

How severe is the problem? Among elite competitors who participated in the prestigious Mr. Olympia “open” category, the study found that 7% died during the study period, including 5% from sudden cardiac death at an average age of just 36 years.

Key Findings on Bodybuilding Mortality

• Sudden cardiac death was the leading cause of death (38% of all deaths)
• Professional bodybuilders had a 5.23 times higher risk of sudden cardiac death than amateurs
• The incidence of sudden cardiac death in currently competing athletes was 32.83 cases per 100,000 athlete-years
• Available autopsies consistently showed severely enlarged hearts (cardiomegaly) and ventricular hypertrophy
• No junior athletes (under 24) died from sudden cardiac death during the study period
• The “men’s bodybuilding” division had five times higher risk of cardiac death than the “classic physique” division

Why Bodybuilders Face Heightened Risks

The research points to several factors that may contribute to the elevated mortality rates, including extreme training regimens, restrictive diets, rapid weight loss strategies, dehydration practices, and the widespread use of performance-enhancing substances.

“Bodybuilding involves several practices that could have an impact on health,” Dr. Vecchiato explains. “These approaches can place significant strain on the cardiovascular system, increase the risk of irregular heart rhythm, and may lead to structural heart changes over time.”

While limited autopsy data hampers definitive conclusions about underlying causes, the available reports revealed severe left ventricular hypertrophy (thickened heart muscle) and cardiomegaly (enlarged heart) in most cases. While some heart enlargement can occur with intense strength training, the extreme changes observed suggest potential contributions from performance-enhancing drug use.

In cases where toxicology reports were available, evidence of anabolic-androgenic steroid use was found in 60% of the athletes. At least 16 other deceased bodybuilders had documented histories of performance-enhancing drug use.

Mental Health Concerns Emerge

Beyond cardiovascular issues, the study highlighted concerning rates of deaths from unnatural causes, including suicide, homicide, vehicle accidents, and overdoses, accounting for approximately 15% of fatalities.

“These findings underline the need to address the psychological impact of bodybuilding culture. These mental health challenges, sometimes worsen with substance abuse and can elevate the risk of impulsive or self-destructive behaviours,” Dr. Vecchiato noted.

The psychological pressure to achieve extreme physiques, combined with the effects of performance-enhancing substances and extreme dieting, may contribute to mental health vulnerabilities within the bodybuilding community.

Call for Preventive Measures

Researchers emphasize that the study was not intended to criticize bodybuilding but rather to highlight an urgent health concern requiring attention. Unlike many other sports, bodybuilding generally lacks systematic medical screening, pre-participation evaluations, or rigorous anti-doping measures.

“For bodybuilders, the message is clear: while striving for physical excellence is admirable, the pursuit of extreme body transformation at any cost can carry significant health risks, particularly for the heart,” says Dr. Vecchiato. “Awareness of these risks should encourage safer training practices, improved medical supervision, and a different cultural approach that firmly rejects the use of performance enhancing substances.”

The study authors call for collaborative partnerships between the bodybuilding community, sports federations, and medical associations to implement preventive measures, including cardiovascular screening, psychological support, and more robust anti-doping controls.

While the researchers acknowledge limitations in their web-based methodology for identifying deaths, they note that their approach likely underestimates rather than overestimates the true mortality rates among bodybuilders.

The team is now working on a similar study focusing on female bodybuilders and plans to investigate whether mortality patterns have changed over time as training practices and pharmacological approaches have evolved.

The research serves as a reminder that impressive muscularity should not be confused with health, and that the influence of professional bodybuilders extends far beyond competitive stages to affect fitness enthusiasts worldwide, making this an important public health concern.