Muscle Gains vs Heart Strain: A Deadly Trade-off?
Sudden cardiac deaths (SCDs) appear to be more frequent among men who practice bodybuilding, particularly those competing at high levels. A global study of more than 20,000 athletes is the first to report the incidence of sudden death in this population. As the author noted in the European Heart Journal , the aim was not to demonize bodybuilding but to promote safer practices.
Bodybuilding focuses on increasing muscle mass and definition through physical exercise and a targeted diet. Unlike traditional sports, bodybuilding competitions evaluate the aesthetics of the body rather than athletic performance.
Researchers identified 20,286 men who had competed in the International Fitness and Bodybuilding Federation (IFBB) events between 2005 and 2020. Using web-based searches, they determined which athletes died. Over a mean follow-up period of 8.1 ± 3.8 years, there were 121 deaths. Among the 99 cases with documented causes, 73 were sudden. The mean age at the time of death was 45 years. Of the 55 nontraumatic sudden deaths — excluding those from car accidents, suicide, or homicide — 46 were classified as SCDs.
The overall incidence of deaths (sudden and nonsudden) was 63.61 per 100,000 person-years. Among active competitors, those who died within 1 year of their last IFBB event, the rate rose to 80.58. The incidence of SCDs was 24.18 in the entire cohort and 32.83 among competing athletes, who had a mean age of just 35 years at death. Professional bodybuilders had a fivefold higher risk for SCD than recreational bodybuilders (hazard ratio, 5.23 [3.58-7.64]). Available autopsies showed the presence of cardiomegaly and severe ventricular hypertrophy in 4 out of 5 cases.
Risk Factors
The study pointed to a broader issue in addition to bodybuilders, which could also affect nonprofessional athletes who practice strength training.
What are the possible causes? Univadis Italy , a Medscape Network platform, asked Marco Vecchiato, MD, a specialist and researcher in the Sports and Exercise Medicine Division at the University of Padua, Padua, Italy, and the coordinator of the study.
'Our study had epidemiological purposes and was not designed to identify, in a cause-effect manner, the mechanisms underlying these premature deaths. However, the literature in the field has advanced some plausible hypotheses, suggesting that a combination of factors could contribute significantly to the increased risk,' said Vecchiato.
These include:
Intense training regimens, such as high-intensity workouts, place major strain on the cardiovascular (CV) and muscular systems.
Extreme dietary practices, such as high protein intake and repeated weight cycling between off-season and on-season periods, can place significant stress on metabolic and CV systems.
Dehydration techniques, such as rapid fluid loss before events using hydro-saline protocols or diuretics, can be dangerous.
The use of doping substances, especially anabolic steroids and similar agents, can severely harm the CV, kidneys, liver, and nervous system.
Doping Impact
'It is important to underline that, to date, there are no studies that have exclusively investigated the risk for death and SCD in a population of bodybuilders with the guarantee of not taking doping substances. However, recent evidence published in first-time journals and with long-term monitoring suggested a clear difference in terms of cumulative mortality between athletes with and without a history of anabolic steroid abuse,' said Vecchiato.
He noted that performance-enhancing drug use is likely to be widespread at the highest competitive levels. In the US, where bodybuilding is more structured and athletes face intense competitive and aesthetic pressure with serious psychophysical consequences, many athletes speak openly about the use of performance-enhancing drugs.
However, in Italy, 'The issue remains mostly hidden and is often not perceived as a medical risk but as 'a necessary means' to obtain a certain physique,' he said.
Uncertain Rules
Athletes are generally required to undergo regular medical checkups, but does the same apply to bodybuilders?
'In Italy, there are numerous bodybuilding federations, each with its own rules and requirements for membership. Some of these clearly state the obligation to present a competitive sports medical certificate, while others do not mention any specific medical requirements, thus allowing membership even in the absence of a health assessment. In these cases, the activity is not formally classified as a sport but rather as an activity for aesthetic purposes, which allows you to bypass some obligations required for competitive sports, including medical certification,' Vecchiato explained.
Although not formally required by regulations, a sports center or gym may still ask a bodybuilder to provide a noncompetitive medical certificate, often for insurance purposes. Under Italian law, such certification is not mandatory for individuals engaging in noncompetitive physical activity unless they are affiliated with a national sports federation or a sports promotion body recognized by the Italian National Olympic Committee, which oversees organized sports and fitness initiatives in the country.
'This heterogeneous regulatory situation means that some athletes are subjected to in-depth sports medical check-ups annually, including a baseline electrocardiogram, stress test, spirometry, urine test, and any further investigations of a higher order, while others receive an evaluation with only an electrocardiogram in resting conditions. Finally, a nonnegligible portion of subjects may never be subjected to any structured medical evaluation, not even when starting or continuing the activity practiced,' he said.
'The first contact with a doctor can therefore only occur after the onset of advanced signs or symptoms, sometimes linked to already structured CV or metabolic damage, making any form of secondary prevention potentially late,' he said.
These signs warrant cardiologic or psychological evaluation.
'The general practitioner can play a key role in recognizing warning signs (excessive muscle hypertrophy, extreme weight fluctuations, suspected use of illicit substances, marked and sudden mood changes in the absence of diagnosed mental illnesses, gynecomastia, extensive acne in adults not present during puberty, etc.) and directing them towards cardiological or psychological investigations,' warned Vecchiato.
He also noted that 15% of SCDs in this population were traumatic. Obsessive body transformation goals, extreme practices, and substance misuse increase the risk for impulsive or self-harming behavior. This reinforces the need to prioritize the mental health of athletes.
Vecchiato concluded that 'in addition to an intensified antidoping practice, the introduction of targeted CV screening and educational campaigns could significantly reduce the associated risks.'
Raising awareness can encourage athletes to adopt safer training and nutrition programs and diets, to be supervised by a physician, and to refuse doping.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Yahoo
29 minutes ago
- Yahoo
A simple blood test could offer first reliable diagnosis for ME
A simple blood test could provide the first reliable diagnosis for myalgic encephalomyelitis (ME) and end the lengthy process of trying to identify the debilitating condition, scientists have found. It's thought more than 400,000 people in the UK suffer with the condition, also known as chronic fatigue syndrome (CFS). Pain, brain fog and extreme low energy that does not improve with sleep are just some of the symptoms of ME. There is no cure and the cause is unknown. Currently the only way to diagnose it is by ruling out other illnesses – a long process that can mean patients wait years for a diagnosis. However, researchers at the University of Edinburgh believe they have made a breakthrough. The study published in the Journal EMBO Molecular Medicine used data from the UK Biobank – a large-scale resource based on the health data and biological samples of 500,000 UK participants. Researchers compared blood samples from 1,455 ME patients with more than 131,000 healthy people. They identified differences in cell counts and molecules that differed in concentrations between the two. The differences in samples for the ME patients were related to chronic inflammation, insulin resistance and liver dysfunction. These findings were compared and replicated in data from a group of American patients and healthy controls. Researchers found 116 'biomarkers' for ME in the blood of men and women with the condition. This is a key finding because the condition affects men and women differently. Professor Chris Ponting, of the university's Institute of Genetics and Cancer, said: 'For so long people with ME/CFS have been told it's all in their head. It's not. We see [it] in their blood. 'Evidence of a large number of replicated and diverse blood biomarkers that differentiate between ME/CFS cases and controls should dispel any lingering perception it is caused by deconditioning and exercise intolerance.' These biomarkers did not change when the participants were any more active – consistent with the view graded exercise therapy, which aims to gradually increase activity levels, is unlikely to be helpful. In fact, the largest differences were seen in people who reported post-exertional malaise. This is when the symptoms of the condition become worse even after minor physical effort. Dr Sjoerd Beentjes, of the university's School of Mathematics, said: 'Blood differences are sometimes attributed to reduced activity levels rather than ME/CFS directly. Our study provides strong evidence ME/CFS affects blood traits through paths other than activity.' However, this research is still at an early stage and there is no guarantee a test will be possible, study authors stressed. Professor Kevin McConway, Emeritus Professor of Applied Statistics, Open University, who was not part of the study, said: 'There is a lot more to do.' 'These findings could help in finding a set of blood biomarkers that can reasonably reliably distinguish people with ME/CFS from those who do not have that condition, but that, without a lot of further work, the findings do not in themselves provide such a set of biomarkers,' he added.
Medscape
33 minutes ago
- Medscape
Preemptive TIPS Promising for Fundal Variceal Bleeding
TOPLINE: In patients with cirrhosis and acute fundal variceal bleeding, the use of preemptive transjugular intrahepatic portosystemic shunt (p-TIPS) with a covered stent within 72 hours of initial bleeding resulted in superior outcomes, with a higher probability of patients being free of death or rebleeding at 1 year than those using standard treatment. METHODOLOGY: Researchers conducted a randomised trial across 17 tertiary centres in France to compare two strategies for preventing rebleeding of non-type 1 gastro-oesophageal varices. They included 101 patients with cirrhosis and acute fundal variceal bleeding (mean age, 58.2 years; 80% men) from January 3, 2019, to February 25, 2023, who achieved initial haemostasis with endoscopic glue injection for at least 12 hours. Patients were randomly assigned to either receive p-TIPS within 72 hours of the initial endoscopic glue injection (n = 47) or continue with on-demand glue obliteration combined with non-selective beta blockers (n = 54). The primary composite endpoint was all-cause mortality or clinically significant rebleeding, defined as recurrent melena or haematemesis requiring hospitalisation or blood transfusion or causing a 3 g/dL drop in haemoglobin, within 1 year from the initial haemostasis. Analyses were conducted in the modified intention-to-treat population. TAKEAWAY: The 1-year probability of being free from death or rebleeding was higher in the p-TIPS group than in the glue obliteration and non-selective beta-blocker group (77% vs 37%; hazard ratio, 0.25; P < .0001). The overall survival did not differ significantly between the two groups; however, 37% of patients in the glue obliteration and non-selective beta-blocker group required TIPS after a median of 25 days. The cumulative incidence of hepatic encephalopathy at 1 year was 35% in the p-TIPS group and 32% in the glue obliteration and non-selective beta-blocker group. Complications related to glue injection occurred in 22 procedures, including 13 bleeding episodes, eight glue migrations (three in the p-TIPS group and five in the glue obliteration group), and one case of cardiac decompensation in the p-TIPS group. The number of patients who experienced any adverse or serious adverse event did not differ significantly between the groups, and no deaths were considered related to the treatment. IN PRACTICE: "The results of the present study strongly support the use of p-TIPS in the management of acute gastric variceal bleeding and add an additional argument in favour of TIPS, which improves prognosis by effectively treating the haemodynamic disorders associated with cirrhosis," the authors of the study wrote. "In patients with cirrhosis and bleeding from fundal varices, p-TIPS with a covered stent is associated with markedly decreased death or rebleeding and should therefore be considered as a first-line therapy," they added. SOURCE: This study was led by Jean-Paul Cervoni, MD, Service d'Hépatologie et de Soins Intensifs, CHU Besançon, Besançon, France. It was published online on June 12, 2025, in The Lancet Gastroenterology & Hepatology. LIMITATIONS: A small sample size precluded definitive subgroup analyses (eg, variceal type). An overrepresentation of alcohol-related cirrhosis may have limited the applicability of the findings to other aetiologies. Eight patients in the p-TIPS group were treated beyond the 72-hour window. DISCLOSURES: This study was funded by the French Ministry of Health. Two authors reported receiving payment for lectures and one author reported receiving consulting fees from Gore. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
33 minutes ago
- Medscape
AI Enhances Prostate Cancer Detection in MRI Analysis
TOPLINE: In a large-scale diagnostic study, artificial intelligence (AI) assistance led to a superior improvement in prostate cancer detection on MRI, increasing diagnostic accuracy by 3.3% compared with unassisted readings. AI support enhanced both sensitivity (96.8%) and specificity (50.1%) at detecting clinically significant prostate cancer (csPCa). METHODOLOGY: Researchers conducted a diagnostic observer study in which 61 readers (34 experts and 27 non-experts) across 17 countries assessed 360 MRI examinations of men with prostate cancer (n = 360; median age, 65 years) with and without AI assistance. The AI system used in this study was curated and developed within the international Prostate Imaging-Cancer AI (PI-CAI) Consortium for the detection and diagnosis of csPCa. The primary objective was to assess whether AI-assisted csPCa diagnosis was superior to unassisted diagnosis at the patient level using the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity at a Prostate Imaging Reporting and Data System threshold of 3 or more. TAKEAWAY: Among 360 men who were examined, 122 harboured csPCa. The AUROC was 0.916 with AI assistance vs 0.882 without, showing an improvement of 3.3% (P < .001). The sensitivity was 96.8% for AI-assisted assessments vs 94.3% for unassisted assessments, showing a significant improvement of 2.5% (P < .001). Likewise, the specificity was 50.1% for AI-assisted vs 46.7% for unassisted assessments, showing an improvement of 3.4%. Non-expert readers showed greater performance improvement with AI assistance than expert readers, achieving higher AUROC scores than those of unassisted experts. IN PRACTICE: "The findings of this diagnostic study suggest the potential of AI assistance in improving csPCa diagnosis when compared with unassisted assessments of biparametric MRI, with statistically significant improvements observed across AUROC, sensitivity, and specificity at a PI-RADS [Prostate Imaging Reporting and Data System] score of 3 or more. Notably, nonexpert readers demonstrated higher benefits from AI assistance compared with expert readers," the authors wrote. SOURCE: This study was led by Jasper J. Twilt, MSc, Minimally Invasive Image-Guided Intervention Center, Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands. It was published online on June 13, 2025, in JAMA Network Open. LIMITATIONS: The data included were retrospectively curated within the scope of PI-CAI, resulting in a mix of consecutive and sampled cohorts. The study's generalisability requires further validation across external cohorts with varying disease prevalence, image quality, and other clinical factors. The controlled online reading workstation environment differed from readers' native settings, potentially affecting diagnostic performance. This study did not assess workflow efficiency or the clinical applicability of performance improvements in real clinical settings. DISCLOSURES: This study received funding support from Health-Holland and the European Union's Horizon 2020. Several authors reported receiving personal fees and research funding and having other ties with various sources. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
