May 28, 2025, 6:32 pm | Read time: 6 minutes
There are many individual reports of deceased bodybuilders, but until now, there have been no larger, systematic studies on the causes of these deaths. An international team of sports medicine specialists and cardiologists has filled this knowledge gap by closely examining 121 verified deaths of male bodybuilders. The risk of sudden cardiac death is particularly shockingly high among professionals.
Bodybuilders impress with massive muscles and iron will—they represent strength, discipline, and perseverance. The downside: Bodybuilders—especially professionals—have a significantly increased risk of sudden cardiac death. There are many case reports on these deaths, but now, for the first time, a systematic, large-scale study with long-term data on this topic is available. FITBOOK took a closer look at the study.
Overview
What Was Investigated and Why?
The study examined the mortality of male bodybuilding athletes who participated in official competitions of the International Federation of Bodybuilding and Fitness (IFBB). Numerous reports of sudden deaths of prominent bodybuilders, which have caused a stir in recent years, prompted researchers to scientifically investigate the phenomenon for the first time. Sudden cardiac death (SCD) was particularly in focus, as it is often associated with undetected heart conditions or the abuse of performance-enhancing substances such as anabolic steroids.1
The aim of the study was to provide a realistic picture of the health risks in bodybuilding and to examine possible risk factors such as age, professional status, competition class, and substance abuse in more detail. This is intended to create a basis for prevention, medical care, and education.
Study Design and Methods
The researchers conducted a retrospective cohort study. This means they analyzed past data to investigate deaths among male bodybuilders. They collected information from various publicly accessible sources such as media reports, social media posts, and specialized forums. Each death was then reviewed by at least two independent physicians to confirm the information.
A total of 20,286 male athletes who participated in at least one official IFBB competition between 2005 and 2020 were included in the analysis. These 20,286 athletes were filtered from an initial pool of over 44,000 reported participants—duplicate entries were removed to accurately evaluate the data.
The researchers followed the athletes for an average of 8.1 years. In total, they were able to record 190,211 so-called “athlete years”—an important basis for calculating the risk of deaths.
The deaths were categorized into four categories:
- Sudden deaths (SD)
- Sudden cardiac death (SCD)
- Traumatic deaths (TSD), such as from accidents
- Non-sudden causes of death
Particularly notable: In some cases, autopsy reports or toxicological analyses showed that the athletes had taken anabolic steroids.
The results were calculated as so-called incidence rates—that is, the number of deaths per 100,000 athlete years. The data was further analyzed by age groups, competition classes, and professional status to identify possible differences more precisely.
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What Were the Results of the Study?
40 Percent Died from Sudden Cardiac Death
The analysis of 20,286 male bodybuilders over a total of 190,211 athlete years resulted in 121 deaths. The most common cause of death was sudden cardiac death (SCD)—a total of 46 cases, accounting for about 38 percent of all deaths.
Significantly Increased Risk for Professional Bodybuilders
Professional bodybuilders were particularly affected: They had more than five times the risk of sudden cardiac death compared to amateurs. The incidence rates paint a clear picture:
- Professionals: 193.63 per 100,000 athlete years
- Amateurs: 11.84 per 100,000 athlete years
Among “Mr. Olympia” participants, the rate was even 386.10 per 100,000 athlete years—a particularly alarming figure. Even among currently active bodybuilders who participated in a competition last year, the risk was increased: 32.83 per 100,000 athlete years.
Deaths During Training, Competition, or Shortly After
A total of 11 active bodybuilders died from sudden cardiac death—some during training, at competitions, or shortly afterward.
Heart Changes and Steroid Abuse as Possible Risk Factors
In several cases, autopsy reports showed significant changes in the heart, including enlargement of the heart muscle (cardiomegaly) and thickening of the heart walls (ventricular hypertrophy). In some cases, toxicological analyses confirmed the abuse of anabolic steroids—a factor that appears to be related to the deaths.
Other Causes of Death
In addition to sudden cardiac deaths, deaths from other causes were documented, including accidents, suicides, and kidney diseases.
What Is the Significance of the Results?
The study shows: Bodybuilding, especially at the professional level, is associated with significant health risks. Unlike many other sports, which often promote cardiovascular health, bodybuilding increases the risk of sudden cardiac deaths—sometimes drastically. Particularly concerning is the high rate of sudden cardiac deaths among active athletes. These figures suggest that extreme training methods, strict diets, dehydration phases before competitions, and especially the use of performance-enhancing substances like anabolic steroids can significantly endanger health.
The study makes it clear: Regular medical examinations—including heart checks like ECGs and ultrasound exams—are urgently needed for bodybuilders. Equally important is better education about the risks of performance-enhancing substances and stricter controls to prevent doping. Even recreational athletes who engage in bodybuilding as a hobby should be aware: Extreme training methods and substance abuse can cause significant health damage. Prevention and education are crucial to minimize risks.
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Study Classification and Possible Limitations
Largest Analysis of Its Kind—But with Weaknesses
The study is the first systematic, large-scale investigation with long-term data on the topic of mortality in bodybuilding. It, therefore, provides important insights. However, there are methodological limitations that must be considered.
Data Collection from Public Sources
The deaths were researched from publicly accessible sources such as media reports, social media, and forums. Official death registers or complete medical records were not available. This poses the risk that not all causes of death are known or correctly documented. Additionally, well-known athletes are mentioned more frequently than unknown athletes, which can influence the results.
Lack of Autopsies and Unclear Causes
Autopsy reports and toxicological analyses were only available in a few cases. Therefore, the influence of doping agents like anabolic steroids cannot be conclusively assessed.
Limited Applicability to Other Federations
The study exclusively considered IFBB athletes—athletes from other federations were not included.
Need for Further Investigations
For an even more accurate risk assessment, systematic medical examinations, a central death register, and standardized autopsy reports would be necessary.
Despite these limitations, the study clearly shows: The risk of sudden cardiac death is significantly increased among male bodybuilders—primarily at the professional level.
Conclusion
The international study shows: Male bodybuilders, mainly in the professional sector, have an increased risk of sudden cardiac death. In several cases, heart changes such as cardiomegaly and ventricular hypertrophy were documented, as well as the abuse of anabolic steroids. The results indicate an increased health risk in bodybuilding, particularly in connection with sudden cardiac death.