Female bodybuilders are facing an unusually high risk of sudden cardiac death, according to a landmark global study published in the European Heart Journal on Tuesday. The research—the first large-scale analysis of deaths among female competitive bodybuilders—found that heart-related causes accounted for nearly one-third of all known cases.
Sudden cardiac death, defined as an unexpected death resulting from heart malfunction, is generally rare in healthy individuals. Yet the findings show professional female bodybuilders are more than 20 times more likely to die suddenly from cardiac causes than amateur competitors. The study also uncovered abnormally high death rates from suicide and homicide, underscoring the complex pressures surrounding women in competitive bodybuilding.
The Most Comprehensive Study of Its Kind
Led by Dr Marco Vecchiato and his team at the University of Padova, Italy, the research investigated mortality patterns among 9,447 women who competed in at least one International Fitness and Bodybuilding Federation (IFBB) event between 2005 and 2020. Names were collected from official records and verified online databases covering multiple languages across news, social media, and bodybuilding forums.
By cross-referencing public reports and medical data where available, researchers identified 32 verified deaths, with an average age of death around 42 years. Sudden cardiac death emerged as the most frequent cause, accounting for 31 percent of cases. While rare in the general population of women, this rate surpasses that of other professional athletes, though it still remains below that seen in male bodybuilders.
Cardiovascular Dangers of Extreme Training
Dr Vecchiato explained that extreme training regimens in bodybuilding—combined with restrictive dieting, dehydration cycles, and performance-enhancing substance use—can severely strain the cardiovascular system. “Bodybuilders, both female and male, often engage in intense training and fasting, using dehydration to achieve an extreme physique. These strategies place immense stress on the heart and blood vessels,” he said.
The study raises fresh questions about whether traditional medical screening overlooks the dangers of chronic overtraining and supplement use among female athletes. Competitive preparation cycles, involving low body fat and electrolyte imbalance, are believed to increase the risk of arrhythmias, sudden cardiac arrest, and prolonged stress on heart function.
Beyond the Body: Mental and Emotional Demands
Perhaps even more startling, suicide or homicide accounted for 13 percent of deaths among female athletes—four times higher than in male bodybuilders. According to Dr Vecchiato, this disparity suggests that women may experience “unique psychosocial pressures” linked to body image, intense competition, and the use of performance-enhancing substances.
These findings highlight a broader psychological toll. Beauty standards in professional bodybuilding, emphasizing extreme muscularity alongside femininity, often trigger emotional strain, anxiety, and disordered eating. Combined with performance pressures and social isolation, the environment may heighten mental vulnerability within the sport.
Data Collection and Limitations
Researchers noted that the analysis relied on wide-ranging, web-based investigations in five languages. This approach, while comprehensive, introduced limitations—particularly as unreported deaths or incomplete autopsy data could skew overall interpretation. Only a fraction of cases had confirmed forensic findings, meaning that causes of death were often classified through indirect clinical evaluation rather than official post-mortem examination.
Acknowledging these gaps, the study nonetheless offers the clearest picture yet of female bodybuilding’s mortality trends—a domain long overshadowed by its male counterpart in both research and public perception.
A Growing Community, Rising Concerns
The number of women participating in strength training and bodybuilding competitions has grown rapidly over the past decade. Yet safety research lags far behind participation rates. “Most of the previous data and public discussions focused exclusively on men,” Dr Vecchiato said. “We realized that there was a striking lack of evidence for female athletes in the same conditions.”
The team’s earlier investigation into male bodybuilders had already found similarly elevated death rates due to cardiovascular complications and substance misuse. By comparing both sexes, the current study underscores the critical need for gender-specific cardiovascular guidelines in competitive strength sports.
A Call for Safer Bodybuilding Practices
For female bodybuilders, the message is clear: the pursuit of extreme muscularity and leanness may have life-threatening consequences. “Awareness of these risks is vital to promote safer training practices, informed decision-making, and more health-oriented approaches,” said Dr Vecchiato. He emphasized that both coaches and athletes must prioritize medical supervision, cardiovascular assessments, and nutrition guidance over aesthetics alone.
Furthermore, the study calls for cultural reform within competitive bodybuilding. It urges industry leaders and organizations to rethink judging criteria, discourage harmful cutting methods, and address performance-enhancing drug abuse with stricter oversight. Promoting mental health awareness, peer mentorship, and stress reduction programs could also help counteract psychosocial hazards that contribute to self-harm and violence.
Implications for Sports Medicine
For physicians and sports health professionals, these results underscore an urgent need for proactive cardiovascular screening in competitive athletes of all genders—not only older or high-risk individuals. Sports cardiologists are encouraged to include female strength athletes in heart monitoring programs historically reserved for male endurance or contact sport participants.
“Many young, highly trained women may not perceive themselves as at risk,” Dr Vecchiato explained. “But our data suggest otherwise. We must shift both medical and cultural perspectives—prevention is key, not postcrisis treatment.”
The Next Phase of Research
Dr Vecchiato’s team is now conducting expanded studies comparing mortality patterns across different eras of bodybuilding to assess whether evolving practices and regulations have improved athlete safety. By examining historical trends—from the 1980s to the 2020s—they aim to determine whether current awareness campaigns, anti-doping regulations, and modern nutrition have altered cardiovascular risks.
Future investigations may also explore correlations between anabolic steroid use, hormonal imbalances, and cardiac remodeling in women to help healthcare professionals detect early warning signs.
Balancing Strength and Safety
The data reveal a troubling paradox—while bodybuilding empowers women through discipline and strength, it can also endanger them when taken to extremes. As more women enter competitive strength sports, the industry’s responsibility to ensure safety and education grows proportionally.
This pioneering research serves as both a scientific breakthrough and a societal warning. It highlights the intersection between physical ambition, mental well-being, and cardiovascular risk. True strength, as this study reminds us, lies not only in muscular power, but also in protecting one’s heart and health.
