2021 was a tragic year for the bodybuilding world. Over two dozen professional athletes died suddenly in a 12-month period, making headlines the world over.
The youngest was 27 years old.
Today, a wealth of research suggests that elite athletes tend to live longer than the rest of us, but a spate of premature deaths among bodybuilders in recent years has raised questions about the safety of this particular sport.
A recent study, led by researchers at the University of Padova in Italy, is the first to investigate the risk of sudden death among a large sample of male bodybuilders.
The findings highlight an alarming phenomenon that the authors say can no longer be ignored by athletes, medical associations, or sports organizations.
The analysis tracked more than 20,000 bodybuilders over an average of 8 years, during which time 73 sudden deaths were registered at a mean age of 42.
Some of these deaths were due to steroids or performance-enhancing drugs. Others were due to vehicle accident, murder, or suicide. But by far the most common cause of death was sudden heart failure, including 46 cases.
That is a low absolute risk for bodybuilders in general; however, that is not the case for the most elite professionals. Their risk of sudden heart failure was found to be more than 14 times higher than that of amateur athletes, which suggests that as the sport becomes more serious, it may also become exponentially more dangerous.
When looking only at the bodybuilders who participated in the highest-ranked international bodybuilding competition in the world – the Mr. Olympia ‘open’ category – researchers found an “alarmingly high” death rate.
Out of the 100 elite competitors that took part in the competition over the years, 7 died from sudden causes.
What’s more, five of those deaths were presumed or confirmed cases of sudden cardiac death at a mean age of just 36.
“Current data are alarming,” the international team of authors concludes, “and sufficient to call for the development of specific recommendations for the prevention of sudden death/sudden cardiac death among bodybuilders, including the systematic implementation of bystander automated external defibrillators.”
The analysis is limited by a lack of hard data, as autopsies were only available for about 10 percent of sudden cardiac deaths. This means there aren’t specifics on how and why many of these individual athletes died.
That said, the authors of the study, led by sports medicine researcher Marco Vecchiato from the University of Padova, suspect that extreme training, stringent dietary regimes, and frequent performance-enhancing drug abuse are risking the heart health of very high-level professional bodybuilders.
“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,” explains Vecchiato.
Available autopsies included in the study consistently showed left ventricle thickening and enlarged hearts among bodybuilders.
That aligns with a past autopsy study, which found that the mean heart mass of bodybuilders was nearly 74 percent heavier than normal reference values, and that on average, their left ventricles were 125 percent thicker than the average man’s.
Further research into the particular cardiovascular effects of bodybuilding is needed, including among female athletes, but Vecchiato says 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,” he explains.
“Based on this data, the medical associations cannot ignore this health problem anymore and should collaborate with the respective federations and policymakers to promote safer participation.”
The study was published in the European Heart Journal.
