Why Do So Many Bodybuilders Have Heart Attacks?

Categories: Knowledge Base

The early death of more than a dozen bodybuilders from heart attacks and other heart-related events over the past few years seems surprising given that we’re talking about young men and women who exercise regularly.

However, looking a little more closely at the sport reveals several factors that contribute not only to an elevated risk of heart attacks but also to heart disease, kidney disease, and liver problems.

If you’re an aspiring bodybuilder, athlete, or aficionado of the sport, understanding exactly what is going on—and how to protect yourself—can help you maximize the benefits and prevent another tragedy.

5 Reasons Why Bodybuilders Have Heart Attacks

There are five main reasons why competitive bodybuilders die of heart attacks and heart-related events, each of which compounds the effects of the others. Avoiding or even moderating these factors can help to prevent premature deaths.

Reason #1: Extreme Amounts of Muscle Mass

Building up a certain amount of muscle mass is good for you. In fact, weight training increases the production of nitric oxide, which relaxes the arteries. Moreover, weight training may reduce the risks of heart attack and stroke.

However, when people try to increase their muscle mass beyond what is naturally possible, the cardiovascular system suffers for two reasons:

  1. Muscle has a lot more capillaries than fat, so building an extreme amount of muscle mass makes the heart work a lot harder than it normally would. Asking the same heart to power two or three times as much body weight (especially when that weight is made up of insane amounts of muscle) is like trying to power a V8 with a V4 engine. At some point, the system is going to break down.
  2. It’s impossible to build the amount of muscle mass required to win high-level competitions without using performance-enhancing drugs. These drugs (which we will discuss below) have detrimental effects on the cardiovascular system.

Reason #2: Performance-Enhancing Drugs

To win professional bodybuilder competitions, a staggering number of contestants use performance-enhancing drugs or PEDs. And while PEDs are officially banned by the International Fitness and Bodybuilding Federation, the anti-doping rules aren’t well enforced. Additionally, judges continue to favor a “bigger is better” approach for high-level prizes, which motivates contestants to keep using these drugs in order to win.

Anabolic Steroids

Anabolic steroids increase muscle mass and strength. They also have very damaging effects on the heart.

  1. Taking anabolic steroids interferes with the production of nitric oxide, which is naturally produced during exercise and works to relax the blood vessels and modulate local microcirculation. With less nitric oxide circulating, there is a higher risk of premature hardening of the arteries and the buildup of arterial plaque.
  2. Anabolic steroids raise the circulating sympathomimetic amine levels, which causes the blood vessels to narrow and impedes healthy blood flow.
  3. Anabolic steroids increase mineralocorticoid levels, leading to fluid retention and further increases in blood pressure.

Over time, the complications of taking anabolic steroids can include:

  • Fluid retention
  • Kidney damage
  • Liver damage
  • Alterations to blood cholesterol levels
  • High blood pressure
  • Enlarged heart muscle
  • Cardiomyopathies
  • Coagulation disorders
  • Elevated risk of blood clots
  • Elevated risk of heart attack and stroke
  • Elevated risk of fatal arrhythmias that lead to sudden cardiac arrest

Human Growth Hormone

Human growth hormone is often used together with steroids to help competitive bodybuilders build muscle mass faster. Unfortunately, human growth hormone also increases the risk of:

  • Carpal tunnel syndrome
  • Elevated insulin resistance
  • Type-2 diabetes (a risk factor for heart attack and cardiac arrest)
  • Edema (swelling in the arms and legs)
  • Enlarged breast tissue in men
  • Pain in the joints and muscles
  • Increased risk of some forms of cancer


Insulin is used to prevent muscle breakdown and boost performance. However, taking exogenous insulin and not knowing how to combine it correctly with carbs can cause dangerously low blood sugar levels, leading to coma and death.


Diuretics are taken to remove excess fluids from the body at contest time and help competitive bodybuilders achieve that coveted shredded look. However, removing too much fluid can lead to:

  • Severe dehydration
  • Kidney failure
  • Electrolyte imbalances
  • Heart arrhythmias (and cardiac arrest)
  • Sudden death

Reason #3: Dehydration

Dehydration thickens the blood, increasing the risk of blood clots—especially in the early morning when the blood is thickest. In bodybuilders, the risk of dehydration is especially high for two reasons:

  1. Many bodybuilders take diuretics to remove fluid from the body.
  2. Men who have an enlarged prostate from taking human growth hormone may need to pee more often, discouraging them from drinking anything before bed to ensure a good night’s sleep. Unfortunately, due to a dangerously high level of red blood platelets and the associated risk of blood clots and heart attack, that good night’s sleep could be their last.

Reason #4: Improper Diet

To get that chiseled physique, we might think that bodybuilders eat a diet rich in protein, fiber, and micronutrients. However, many bodybuilders increase their weight in the building phase with low-nutrient, high-calorie foods like cheeseburgers and donuts, which are anything but healthy for the heart.

Reason #5: Lack of Medical Supervision

Finally, many bodybuilders are out there taking PEDs, eating unhealthy foods, and dehydrating their bodies without medical supervision. This means that the normal checks and balances that come with medically prescribed medications are absent, and the first warning sign of a problem may be a heart attack or sudden death.

Safe Weight Training Is Possible

The good news is that weight training, per se, is great for your heart when you follow sensible guidelines and take care of your health. In fact, the Centers for Disease Control and Prevention (CDC) recommends that every adult complete two weight-training sessions per week in combination with 150 minutes of aerobic exercise.

If you want to move into amateur or competitive bodybuilding, there are some very important guidelines to follow to avoid an increased risk of premature death.

  1. Stay hydrated and respond to all signs of thirst.
  2. Balance weight training with aerobic exercise.
  3. Monitor your blood pressure regularly.
  4. Get a physical check-up with blood work at least once a year and more often if you’re using PEDs. This should include things like hematocrit (red blood platelet levels), cholesterol levels, liver function, kidney function, CBC, CMP-14, cortisol, insulin, thyroid hormones, and reproductive hormones.
  5. Make sure there’s an automated external defibrillator like the Philips HeartStart FRx or Physio-Control LIFEPAK CR2 present at home and wherever you work out.

Above all, pay attention to any clear warning signs and change your lifestyle before it’s too late. It’s better to withdraw from a competition or change from the heavyweight to the classic physique category and live to tell the tale.