Sudden cardiac death is responsible for an unusually high proportion of deaths in male bodybuilders worldwide with the highest risk among professional bodybuilders, according to research published in the European Heart Journal [1] today (Wednesday).
Sudden cardiac death is when someone dies suddenly and unexpectedly due to a problem with their heart. It is generally rare in young and apparently healthy individuals, but it is often linked to underlying heart conditions.
Researchers say their findings highlight the health risks associated with competitive bodybuilding and suggest the need for greater awareness, preventive strategies and policy changes within this community.
The study was led by Dr Marco Vecchiato from the University of Padova, Italy. He said: "As a sports and exercise physician, I have come close to the bodybuilding world, and this has given me the opportunity to see not only its many positive aspects, such as the promotion of fitness and self-discipline, but also some of the challenges and risks that are inherently part of this discipline.
"I've seen a growing number of reports of premature deaths among people involved in bodybuilding and fitness. These tragic events, often affecting young and apparently healthy athletes, highlight a gap in our understanding of the long-term health risks associated with competitive bodybuilding. So far, no study has reported the incidence of death and sudden death within this sporting discipline."
Dr Vecchiato and his colleagues gathered the names of 20,286 male bodybuilders from the official competition records and from an unofficial online database. All the men had participated in at least one International Fitness and Bodybuilding Federation event between 2005 and 2020.
The researchers then searched for reports of deaths of any of these named competitors in five different languages across different web sources including official media reports, social media, bodybuilding forums and blogs. Any reported deaths were then cross-referenced using multiple sources and these reports were verified and analysed by two clinicians to establish, as far as possible, the cause of death.
The researchers found 121 deaths among the men, with the average age at death of 45 years. Sudden cardiac deaths accounted for 38% of these. The risk of sudden cardiac death was higher among professional bodybuilders, with a more than fivefold increase compared to amateurs.
In the few autopsy reports that were available, common findings included thickening or enlargement of the heart and, in some cases, coronary artery disease. In some cases, toxicological analyses and publicly available reports revealed abuse of anabolic substances.
Dr Vecchiato said: "Our findings show that the risk of death among male bodybuilders is considerably high. Professional athletes had a markedly higher incidence of sudden cardiac death, suggesting that the level of competition might contribute to this increased risk.
"Bodybuilding involves several practices that could have an impact on health, such as extreme strength training, rapid weight loss strategies including severe dietary restrictions and dehydration, as well as the widespread use of different performance-enhancing substances. 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.
"The risk may be greater for professional bodybuilders because they are more likely to engage intensively in these practices over prolonged periods and may experience higher competitive pressure to achieve extreme physiques.
"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. 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.
"For clinicians, our findings suggest the importance of proactive cardiovascular screening and counselling in this population, even in young and apparently healthy athletes. Based on this data, the medical associations cannot ignore this health problem anymore and should collaborate with the respective federations and policy makers to promote safer participation. Particularly as the approach of famous athletes can also influence many other people who are engaged in strength training in gyms around the world.
"For policy makers and sports organisations, the study underlines the need for a cultural shift in bodybuilding, including stronger anti-doping measures, education campaigns about the risks of drug abuse and certain sport-related practices, and possibly the development of specific health surveillance programmes.
"More broadly, the research challenges the idea that appearance alone is an indicator of health and highlights the hidden risks that can exist behind even the most sculpted physiques. However, our findings are not an indictment of strength training or the fitness culture in general. On the contrary, regular physical activity and strength training can be extremely beneficial for health, quality of life and mortality risk."
Around 15% of deaths were categorised as 'sudden traumatic deaths', including car crashes, suicides, murders and overdoses. "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 added.
The researchers focused on male bodybuilders because they represent the majority of participants at a competitive level, and so more data on men is available. However, they are working on a similar study focusing on female bodybuilders. They also plan to study deaths among bodybuilders over time, to see whether health risks have altered as practices have changed.
