The International Fitness and Bodybuilding Federation (IFBB) organizes the main international championships in bodybuilding and fitness. Bodybuilding is a widely practiced discipline centered on muscle development and overall physical conditioning. It has some concerns about the risks that occur because of it, like sudden cardiac death (SCD) in some famous fitness influencers and famous bodybuilders. This is caused by undiagnosed cardiovascular disease, functional or structural cardiac disorder, exogenous substance abuse, and complex arrhythmias. The causes and risk of SCD are debated, but there is limited scientific evidence from small case series or case reports.
The aim of this study is to analyze the overall mortality incidence and risk of SCD in a large sample of male bodybuilding athletes over a long period. The International Fitness and Bodybuilding Federation (IFBB) is in charge of organizing the main international championships in bodybuilding and fitness. There are three main age categories: master (>40 years), junior (<24 years), and open. Athletes who appeared in at least one official IFBB competition from 2005 to 2020 were found by using the MuscleMemory database and the IFBB website. Case detection included grouping all identified athletes and eliminating duplicates. A PHP-developed software was utilized to match the names with non-standard ASCII characters, and each athlete’s name was placed in a standardized web-based Google search string. Each recognized case was verified and determined by two independent physicians, who cross-referenced multiple sources to learn the identity and details of each death. Deaths are categorized as non-sudden death (NSD) and sudden death (SD) depending on pre-existing conditions. SD was put as traumatic sudden death (TSD) or non-TSD, which includes SCD. Incidence rates were determined by a 95% confidence interval (CI) derived from the Poisson distribution, which reports 100,000 athlete years (AY) events.
Over 16 years, 44,194 athletes competed in 730 IFBB events. The average duration of follow-up was 8.1 ± 3.8 years for 190,211 AY. There were 121 fatalities, with North American athletes accounting for 40.5% of the total. A particular cause of death was established in 78.5% of the cases, with 73 SDs and 22 non-SDs, of which 55 non-TSD and 18 were TSD, including 46 SCDs (38% of total fatalities) at an average age of 42.2 ± 10.9 years. Only five professional athletes’ autopsy reports were available, with 4 exhibiting cardiomegaly and left ventricular hypertrophy, 2 having coronary artery disease, and 1 having a non-ischemic left ventricular scar.
3 out of 5 toxicological investigations revealed anabolic-androgenic steroids (AAS) usage, and at least 16 more athletes claimed a personal history of performance-enhancing drug (PED) consumption or direct testimony. The overall mortality and SCD rates were 63.61 and 24.18 per 100,000 AY, respectively. Master athletes had a 2 fold increased risk of all-cause mortality compared to open athletes, although the risk of SCD appeared to be equivalent. Only 4 fatalities occurred among athletes in the “classic physique” group, which had a 5-fold lower risk of SCD than the “men’s bodybuilding” division. Currently competing athletes had an incidence rate of SCD of 130.04 (42.22 to 303.47) per 100,000 AY, which was almost 6 times greater than that of amateur athletes.
The limitations include dependence on publicly available information, a lack of autopsy results, timing constraints, and restricted language coverage. Future studies should cover additional languages and look at the influence of current procedures and pharmaceuticals on mortality rates. The study highlights the importance of additional research and systematic collection of prospective data to investigate the significance of PED-induced cardiac damage in bodybuilders and how it differs from adaptive remodelling in sports. Safety should be enhanced with targeted preventative measures and educational programs.
Reference: Vecchiato M, Ermolao A, Da Col M, et al. Mortality in male bodybuilding athletes. Eur Heart J. 2025;ehaf285. doi:10.1093/eurheartj/ehaf285
