Pro Bodybuilders Face Over 14 Times Higher Risk Of Sudden Cardiac Death

PADUA, Italy — Behind all that buff bravado, professional bodybuilders face a risk of sudden cardiac death more than 14 times higher than their amateur counterparts. A new international study tracked over 20,000 male bodybuilders across 16 years, uncovering a disturbing pattern of premature deaths that raises serious questions about the safety of competitive bodybuilding at elite levels.

“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 lead author Dr. Marco Vecchiato from the University of Padova in Italy, in a statement.

For anyone who has followed bodybuilding competitions or fitness influencers on social media, the headlines about the sudden deaths of seemingly healthy, muscular athletes have become increasingly common. Now, for the first time, research published in the European Heart Journal gives hard data on just how dangerous the pursuit of extreme muscle development can be.

Startling Death Rates Among Elite Competitors

To calculate risk over time, researchers used a measure called “athlete-years,” which accounts for both the number of athletes in the study and how long each was tracked. For example, following 100 athletes for one year equals 100 athlete-years.

Professional bodybuilders in the study died at a rate of 317.56 deaths per 100,000 athlete-years, far exceeding mortality rates seen in other elite sports. Even more alarming, the incidence of sudden cardiac death (SCD) among currently competing professionals reached nearly 130 cases per 100,000 athlete-years.

For currently competing professional bodybuilders (those who participated in at least one competition within the previous year), the all-cause mortality rate was 208.06 per 100,000 athlete-years.

The risk proved especially high for competitors in the prestigious Mr. Olympia “open” category, where 7% of athletes died during the study period, including 5% from sudden cardiac death at an average age of just 36 years old.

According to the research team, high-level professional athletes face increased health complications due to extreme training regimens, stringent dietary restrictions, and frequent performance-enhancing drug use compared to amateur athletes.

The study identified 121 deaths among 20,286 male bodybuilders who competed in International Federation of Bodybuilding and Fitness (IFBB) events between 2005 and 2020. Researchers followed these athletes for an average of 8.1 years, creating a dataset covering 190,211 athlete-years.

Sudden cardiac death emerged as the leading cause of mortality, accounting for 38% of all identified deaths. Available autopsy reports consistently showed cardiomegaly (enlarged heart) and ventricular hypertrophy (thickened heart muscle walls), conditions that can trigger life-threatening heart rhythms.

While many sports carry risks, bodybuilding appears uniquely dangerous. The research team noted that studies conducted over the past 30 years in young athletes and military personnel have shown variable incidence rates of sudden cardiac death, but all were far lower than what was observed in this bodybuilding sample.

Geographic differences emerged in the data, with most deceased athletes coming from North America (40.5%, primarily from the USA), followed by Europe (38.8%). Deaths were documented across all inhabited continents.

Other Causes of Concern

Beyond cardiac issues, the study found bodybuilders faced elevated risks of kidney-related deaths, with several athletes dying from kidney/multi-organ failure. Other causes included vehicle accidents, cancer, COVID-19 complications, murder/suicide, and drug overdoses.

Mental health concerns were also common. The researchers observed that body dysmorphic disorders combined with substance abuse create an environment that increases the risks of impulsive or self-destructive behaviors.

What makes bodybuilding so dangerous? While the study didn’t definitively answer this question, the researchers pointed to several potential factors, including performance-enhancing drug use. Anabolic-androgenic steroids (AAS) are estimated to be used by more than 75% of male competitive bodybuilders, according to previous research.

These substances can adversely affect the cardiovascular system, contributing to an increased risk of sudden cardiac death. They can lead to hypertension, ventricular hypertrophy, cardiomegaly, and systolic dysfunction.

The extreme practices surrounding competitions may also play a role. Bodybuilders often engage in drastic weight loss before events through severe caloric restriction and dehydration. Five athletes in the study died from sudden cardiac death during or shortly after an official competition.

Lack of Oversight and Testing Concerns

Despite these dangers, bodybuilding lacks the medical oversight common in other sports. Bodybuilding doesn’t typically involve specific medical risk assessment, and many countries don’t even classify it as a sport, which prevents professionals from receiving specific evaluations and medical checks.

The study also raised concerns about inadequate drug testing in competitive bodybuilding. According to the most recent available World Anti-Doping Agency (WADA) report, only 80 samples from IFBB competitions were submitted for doping analyses, resulting in a 13% positive rate. That is over fifty times higher than that reported by FIFA and about five times higher than that of the International Powerlifting Federation.

According to the researchers, these findings prompted WADA to approach the IFBB about its inadequate testing program and insufficient resources devoted to doping control.

The study authors called for collaboration between medical associations and the bodybuilding community to develop preventive strategies, including intensified doping control, regular medical checks, and educational initiatives.

“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,” adds Dr. Vecchiato. “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.”

There is a stark difference in risk between casual gym-goers and elite bodybuilders who push their bodies to extreme limits. The researchers found that classic physique competitors, who face weight-height limits that discourage extreme muscle mass, had a risk of sudden cardiac death five times lower than those in the unlimited “men’s bodybuilding” division.

This is a wake-up call for a sport that has long operated with minimal medical oversight despite mounting evidence of health risks. These alarming death rates point to an urgent need for improved preventive measures to promote safer participation in the sport.