Sudden cardiac death is unusually high among male bodybuilders worldwide, with the highest risk among professional bodybuilders, according to new research published in European Heart Journal.

The study was led by Dr Marco Vecchiato from the University of Padova, Italy, who calls for more awareness and understanding of the impact that bodybuilding can have, such as rapid weight loss and dehydration.

Dr Vecchiato and his colleagues gathered the names of 20,286 male bodybuilders from the official competition records and from an unofficial online database. All the men had participated in at least one International Fitness and Bodybuilding Federation event between 2005 and 2020.

The researchers then searched for reports of deaths of any of these named competitors in five different languages across different web sources. Any reported deaths were cross-referenced using multiple sources and these reports were verified and analysed by two clinicians to establish, as far as possible, the cause of death.

The researchers found 121 deaths among the men, with the average age at death of 45 years. Sudden cardiac deaths accounted for 38 per cent of these. The risk of sudden cardiac death was higher among professional bodybuilders, with a more than fivefold increase compared to amateurs.

In the autopsy reports that were available, common findings included thickening or enlargement of the heart and – in some cases – coronary artery disease. Some cases revealed abuse of anabolic substances.

Dr Vecchiato said: "Bodybuilding involves several practices that could have an impact on health, such as extreme strength training, rapid weight loss strategies – including severe dietary restrictions – and dehydration, as well as the widespread use of different performance-enhancing substances. 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.

"For bodybuilders, 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. Awareness of these risks should encourage safer training practices, improved medical supervision, and a different cultural approach that firmly rejects the use of performance enhancing substances.”

Dr Vecchiato also called for cardiovascular screening and for policy makers and sports organisations to develop stronger anti-doping measures, education campaigns and health surveillance programmes.

The researchers are working on a similar study focusing on female bodybuilders. They also plan to study deaths among bodybuilders over time, to see whether health risks have altered as practices have changed.