The sculpted physique that defines professional bodybuilding can obscure unsettling healthy reality. A new study shows that male bodybuilders have unusually high sudden death rates, with professional competitors facing more than five times the risk that they are amateurs.
The first study published in the European Heart Journal traces more than 20,000 male bodybuilders who competed in the International Federation of Bodybuilding and Fitness (IFBB) between 2005 and 2020 and found patterns of death that challenged the health of these athletes.
Hidden risks behind muscle forms
During an average 8-year follow-up period, the researchers identified 121 deaths in the athletes studied, with sudden heart death accounting for 38% of these deaths. Professional bodybuilders have a very high risk, and the mortality rate is more than seven times that of their amateur peers.
“Our findings suggest that male bodybuilders have a high risk of death,” said Dr. Marco Vecchiato, who led the study, who led the study. “The incidence of sudden cardiac death in professional athletes is significantly higher, suggesting that the level of competition may lead to this increased risk.”
How serious is the problem? Among elite competitors participating in the prestigious Olympia “Open” category, the study found that 7% of people died during the study period, including 5% of heart deaths, with an average age of only 36 years.
Key findings on bodybuilding mortality
- Heart death is the main cause of death (38% of all deaths)
- Professional bodybuilders have 5.23 times risk of heart death than amateurs
- Current incidence of sudden heart death in competing athletes is 32.83 per 100,000 athletes a year
- Available autopsy always show severe enlarged heart (cardioma) and ventricular hypertrophy
- No juvenile athletes (under 24 years of age) died of heart death during the study period
- “Male Bodybuilder” has five times the risk of heart death than the “Classic Physical” department
Why bodybuilders face higher risks
Studies have shown that several factors that may lead to increased mortality include extreme training protocols, restrictive diets, rapid weight loss strategies, dehydration practices, and widespread use of performance-enhancing substances.
“Bodybuilding involves several practices that may affect health,” explains Dr. Vecchiato. “These methods can put significant stress on the cardiovascular system, increase the risk of irregular heart rhythms, and may lead to structural heart changes over time.”
Although limited autopsy data hinder clear conclusions about the underlying cause, available reports show severe left ventricular hypertrophy (myothelium) and heart enlargement (heart enlargement) in most cases. Although some heart enlargement may occur with intense strength training, the observed extreme changes suggest that drug use that enhances performance may contribute.
In the case of toxicology reports, evidence of anabolic androsoids was found in 60% of athletes. Bodybuilders of at least 16 dead bodies have documented a history of enhanced performance drug use.
Mental health problems arise
In addition to cardiovascular problems, the study highlighted unnatural mortality rates, including suicide, homicide, vehicle accidents and overdose, accounting for approximately 15% of the death toll.
“These findings emphasize the need to address the psychological impact of bodybuilding culture. These mental health challenges can sometimes be aggravated by substance abuse and may increase the risk of impulsive or self-destructive behaviors,” Dr. Vecchiato noted.
The psychological stress of achieving extreme physiques, coupled with the effects of enhanced performance substances and extreme dieting, may lead to mental health vulnerability within the bodybuilding community.
Call for preventive measures
The researchers stressed that the study was not to criticize bodybuilding, but to highlight urgent health issues that need attention. Unlike many other sports, bodybuilding often lacks systematic medical screening, pre-participation assessments, or strict anti-doping measures.
“For bodybuilders, this message is clear: while hard work to be an admirable body, the pursuit of extreme body transformation at any cost can pose significant health risks, especially to the heart,” said Dr. Vecchiato. “Awareness of these risks should encourage safer training practices, improved medical supervision, and another cultural approach to a firm rejection of the use of performance-enhancing substances.”
The study authors call for partnerships between bodybuilding communities, sports federations and medical associations to implement preventive measures including cardiovascular screening, psychological support and stronger anti-doping control.
Although the researchers acknowledge the limitations of web-based approaches to identify death, they noted that their approach may underestimate, rather than overestimate, the real mortality rate among bodybuilders.
The team is now studying a similar study for female bodybuilders and plans to investigate whether death patterns have changed over time as training practices and pharmacological approaches develop.
This study reminds people that impressive muscles should not be confused with health and that the impact of professional bodybuilders goes far beyond the competitive stage to affect fitness enthusiasts around the world, making this an important public health issue.
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