Professional male bodybuilders have a significantly higher incidence of death, including a fivefold higher risk of sudden cardiac death (SCD) compared with amateur bodybuilders, according to a study published May 20 in the European Heart Journal.

Marco Vecchiato, MD, et al., analyzed athletes who participated in at least one International Fitness and Bodybuilding Federation (IFBB) competition between 2005 and 2020 to determine the risk of mortality and incidence of SCD. The study included 20,286 athletes competing in 730 IFBB events, with a mean follow-up of 8 years.

Findings revealed 121 deaths during the study period (mean age, 45.3 years), for an incidence of 81 per 100,00 athlete years. Among these, 73 were considered sudden deaths, of which 46 were classified as SCD (38% of total deaths), including 11 in currently competing athletes, for an incidence of 32.83 per 100,000 athlete-years. Common SCD findings included cardiomegaly and ventricular hypertrophy, according to the few available autopsy reports.

Notably, professional bodybuilders vs. amateurs had a considerably higher risk for SCD (hazard ratio, 5.23), indicating the level of competition might contribute to the increased risk. Possible reasons cited include anabolic steroid intake or performance-enhancing drug (PED) abuse, extreme strength training, and rapid weight loss strategies like severe dietary restrictions and dehydration, all straining the cardiovascular system. The authors also highlight the potential impact of bodybuilding on mental health and psychosocial factors.

Vecchiato and colleagues say their findings highlight the health risks associated with competitive bodybuilding and suggest the need for greater awareness, preventive strategies including regular medical exams, and policy changes within the bodybuilding and medical communities to make sports participation safer.

Specifically, "besides a required intensification of doping control, our study emphasizes the need for further research … to explore the implications of PED-induced cardiac toxicity in bodybuilders and its differentiation from adaptive remodelling in athletes," the authors write. "Finally, safety should be improved by specific preventive measures, also with educational initiatives possibly leading to a cultural shift in the athletic approach."