Is extreme bodybuilding putting your heart at risk? Here's what the study says

For a sport that glorifies control, strength, and discipline, bodybuilding conceals a sobering truth—behind the muscle and dedication lies a disproportionately high risk of sudden cardiac death.


Bodybuilders push their limits through intense exercise, strict diets, and in some cases, the abuse of performance-enhancing drugs. While the result is a sculpted body, it comes at a cost, and as per a recent study, the tradeoff is human life being cut short.


That stark conclusion is drawn from a large-scale study published on May 20 in the European Heart Journal. Researchers tracked 20,286 male bodybuilders who had competed in at least one bodybuilding event between 2005 and 2020. The findings revealed that professional bodybuilders were twice as likely to die from sudden cardiac death as the general population—and five times more likely than amateur bodybuilders.




“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,” said study co-author Dr. Marco Vecchiato, sports medicine specialist at the University of Padova, Italy.

A global Pattern The study identified 121 deaths among competitive bodybuilders, with the average age at death just 45. Of these, about 40% were sudden and heart-related, often caused by underlying, often undetected, cardiac issues. The breakdown of deaths by geography painted a global picture of the crisis:
North America: 40.5% (mostly USA)


Europe: 38.8%


Asia: 7.4%


Africa: 6.6%


South America: 5%


Oceania: 1.7%




The data was compiled through official records, social media posts, news reports, forums, and blogs in five different languages. Death reports were meticulously cross-verified and analyzed by two clinicians to confirm the cause of death.


The cardiac cost of building muscle
Autopsy findings from some of the deceased athletes showed signs of thickened or enlarged hearts and coronary artery disease. In several cases, toxicology reports and public information confirmed the use of anabolic steroids and other performance-enhancing substances, which are known to strain the cardiovascular system.



Medical experts warn that these substances, often used without medical oversight, can lead to arrhythmias, heart failure, and sudden cardiac arrest—especially when combined with dehydration and intense training.

Psychological toll
The study didn’t just stop at physical health. Around 15% of the deaths were categorized as sudden traumatic deaths—including suicides, overdoses, car crashes, and murders—highlighting the mental health challenges many athletes face in high-stakes competitive environments.


Additional research—including a 2021 Frontiers in Psychology review—points to body dysmorphia, depression, and obsession with appearance as key mental health issues among competitive bodybuilders. “The pressure to achieve social ideals of muscularity may contribute to psychological distress, body dissatisfaction, and athletes may develop or worsen body dysmorphic disorders,” the study noted.