Bodybuilding: the deadly risk isn't just for men
24.10.2025
A new large-scale study, the first to systematically investigate deaths among competitive female bodybuilders, conducted by Marco Vecchiato from the University of Padua, raises alarms about the use of performance-enhancing substances, extreme practices, and aesthetic expectations: heart health and psychological balance at risk. According to the research published in the European Heart Journal, sudden cardiac death accounts for an unusually high proportion of deaths among female bodybuilders worldwide.
The study also highlights a high proportion of deaths by suicide and homicide among female bodybuilders.
"Bodybuilders, both women and men, often engage in extreme training and use fasting and dehydration strategies to achieve extreme physiques. Some also take performance-enhancing substances. These strategies can have a severe impact on the heart and blood vessels," explains Marco Vecchiato, the study's author, who has also recently published research on mortality among male bodybuilders.
Researchers gathered the names of 9,447 female bodybuilders who had participated in at least one event of the International Federation of Fitness and Bodybuilding between 2005 and 2020. They then searched for death reports of these named competitors in five different languages through various web sources, including official media, social media, bodybuilding forums, and blogs. Any reported deaths were verified using multiple sources, and these reports were analyzed by two clinicians to determine, as accurately as possible, the cause of death.
The results showed 32 deaths among the women, with an average age at death of around 42 years. Sudden cardiac death was the most common cause of death, accounting for 31% of the cases. The risk of sudden cardiac death was more than 20 times higher among professional bodybuilders compared to amateurs.
These data indicate that the risk of sudden cardiac death appears to be much higher in female bodybuilders compared to other professional athletes, although lower than the same risk for male bodybuilders. Suicide or homicide accounted for 13% of the deaths, which was four times higher than among male bodybuilders. "This surprising difference suggests that, in addition to cardiovascular risks, female athletes in this field may face unique psychosocial pressures, possibly related to body image expectations, the use of performance-enhancing substances, or the extreme demands of the sport," notes Marco Vecchiato.
The study's authors acknowledge that the data collected was based on a web search strategy, which could have influenced their results. For example, some deaths, especially among less well-known athletes, might not have been reported. They also found that autopsy data was available for only a small proportion of cases, meaning sudden deaths had to be classified based on clinical interpretation rather than confirmed forensic results.
However "For female bodybuilders, this research is a reminder that the pursuit of extreme muscularity and leanness, while often celebrated, can come at a cost to health, particularly cardiovascular health. Awareness of these risks is essential to promote safer training practices, informed decisions, and a more health-oriented approach in competitive bodybuilding," states Vecchiato. "There also needs to be a cultural shift in the sport to raise awareness of these risks, not only among professionals but also within the broader community of women engaged in high-intensity strength training."
For clinicians, especially those working in sports medicine and sports cardiology, these findings underscore the need for proactive screening and counseling, even for young and seemingly healthy athletes, as these individuals might not perceive themselves as at risk, contrary to what the data suggests.
Marco Vecchiato and his team are now studying health outcomes for athletes across different historical eras of bodybuilding to see if changing practices have impacted the causes and rates of deaths.
