The risks associated with competitive bodybuilding were outlined in a 2025 study in which researchers followed approximately 20,000 amateur and professional bodybuilders who competed between 2005 and 2020.

The study, published in the European Heart Journal, found that professional bodybuilders were more than five times as likely as amateurs to experience sudden cardiac death (SCD), in which the heart suddenly stops beating.

Sudden cardiac death is rare among young, healthy people and is often associated with underlying cardiovascular conditions, the BBC reports.

The study identified 121 deaths, 46 of which were classified as sudden cardiac deaths.

The average age at death was 45, but among athletes who were actively competing, it was just 34.7 years.

The study’s lead author, Dr. Marco Vecchiato of the University of Padua in Italy, noted that several factors may have contributed to the deaths of bodybuilders, including the “widespread use” of performance-enhancing drugs, rapid weight loss before competitions, and “extreme strength training.”

Another study, published in Circulation in 2025, followed 1,189 men known to use anabolic steroids for 11 years and compared them with nearly 60,000 men from the general population.

The researchers found that steroid users were nearly nine times more likely to develop cardiomyopathy, a condition that weakens the heart muscle. Their risk of heart attack was three times higher, while their risk of heart failure was more than three times higher.

In addition to causing other health problems in men, including reduced sperm count and erectile dysfunction, anabolic steroids can increase blood pressure, accelerate the buildup of plaque in the arteries, and cause structural changes in the heart itself.

In the study published in the European Heart Journal, researchers analyzed autopsy findings from bodybuilders who had died.

In many cases, they found enlarged hearts and left ventricular hypertrophy — thickening of the heart’s main pumping chamber, which can increase the risk of abnormal heart rhythms and heart failure.

In some cases, toxicology tests and publicly available reports revealed the misuse of anabolic substances that are not routinely included in standard autopsy screening.

An enlarged heart was frequently found among bodybuilders who died at a young age.