Bodybuilding's richest season yet, and the mortality data running beneath it

Competitive bodybuilding has never paid better. At the Arnold Classic in Columbus, Ohio, on 5–8 March 2026, the Men's Open champion Andrew Jacked took a $750,000 winner's purse, reported as the largest in the sport's history, ahead of Nick Walker, Hadi Choopan, Martin Fitzwater and Brandon Curry [s5]. Five months earlier, at Resorts World Las Vegas in October 2025, Derek Lunsford won Mr. Olympia and its $600,000 first prize, with Choopan second and Jacked third [s6].

Running underneath that season is a body of evidence that the sport's own governing structures have not yet answered. In August 2025 the European Heart Journal published the largest mortality study of bodybuilders ever conducted; in October 2025 the same group published its female counterpart; and in July 2026 the journal returned to the subject with an editorial titled "Bodybuilders or bodybreakers: when bigger muscles mean bigger health risks" [s1][s2][s3].

What the male cohort found

Researchers identified 20,286 male athletes who competed in 730 International Federation of Bodybuilding and Fitness events between 2005 and 2020, then used a standardised web search with follow-up through July 2023 to detect deaths — an average of 8.1 ± 3.8 years of follow-up, or 190,211 athlete-years of surveillance [s1].

They found 121 deaths. Seventy-three were classified as sudden, and 46 of those as sudden cardiac deaths — 38% of all deaths in the cohort [s1]. Eleven of the sudden cardiac deaths occurred in athletes who had competed within the previous year, at a mean age of 34.7 ± 6.1 years [s1]. Among those currently competing athletes, the incidence of sudden cardiac death was 32.83 per 100,000 athlete-years [s1]. Professional bodybuilders carried a substantially higher risk than amateurs: hazard ratio 5.23 (95% CI 3.58–7.64) [s1].

Where autopsies were available for sudden cardiac death cases, they consistently showed cardiomegaly and ventricular hypertrophy [s1]. The authors' stated conclusion is that the findings should alert the bodybuilding and medical communities to a need for improved preventive measures [s1].

What the female cohort found

The companion study covered 9,447 female athletes across 700 federation competitions over the same 2005–2020 window [s2]. Thirty-two deaths were identified, at a mean age of 42.7 ± 9.8 years, with a cause determined in 24 of them [s2]. Nineteen were sudden — seven traumatic, twelve non-traumatic — and ten were classified as sudden cardiac deaths, 31% of all deaths [s2].

All-cause mortality was 33.51 per 100,000 athlete-years (95% CI 22.92–47.30) and sudden cardiac death 10.47 per 100,000 athlete-years (95% CI 5.02–19.26) [s2]. The professional-versus-amateur split was again stark: 53.98 per 100,000 athlete-years (95% CI 23.31–106.36) in professionals against 2.48 (95% CI 0.30–8.95) in amateurs [s2].

Compared with the male cohort, female rates were lower — a ratio of 0.53 (95% CI 0.35–0.78) for all-cause mortality and 0.43 (95% CI 0.19–0.87) for sudden cardiac death [s2]. Lower is not low. The female professional rate still exceeds the male cohort's overall competing-athlete rate.

Two findings in the female study are worth stating precisely because they are so thinly supported. Autopsy reports were available for only two professional athletes; one showed no cardiac abnormality and one showed myocarditis [s2]. Evidence of performance-enhancing drug use was documented in at least four cases [s2]. Suicide and homicide accounted for 13% of deaths, more than four times the male rate [s2]. With 32 deaths in total, every subgroup here rests on single-digit counts.

Both studies share the same limitations, which the authors name: retrospective design, reliance on publicly available data, no adjustment for confounders, and no systematic autopsy or toxicology [s2]. Deaths detected by web search will miss deaths that were never reported publicly, which biases the counts downward rather than up.

The mechanism question

Neither cohort study can attribute deaths to any specific exposure. What exists is separate evidence that anabolic-androgenic steroids change the heart in the direction the autopsies describe.

The HAARLEM study followed 31 amateur strength athletes with 3D echocardiography before a self-administered steroid cycle, at its end, and roughly a year after inclusion [s4]. Over a median cycle of 16 weeks, 3D left ventricular ejection fraction declined by 4.9% (95% CI −7.2 to −2.5, p < 0.001), the E/A ratio declined by 0.45 (95% CI −0.69 to −0.21, p < 0.001), left atrial volume rose by 9.2 mL (95% CI 2.9–15.4, p = 0.004) and left ventricular mass rose by 28.3 g (95% CI 14.2–42.4, p < 0.001), with the mass increase positively correlated with average weekly dose [s4].

The study's second finding is the one usually left out of summaries: after a median recovery of eight months off drugs, all parameters returned to baseline [s4]. That is 31 amateur athletes over one cycle — not a cohort of long-term professional users, and not a design that could detect what happens after a decade of cycling.

The moving target

A critical review published in March 2026 argues the pharmacology has already shifted past what mortality data captures. It describes a move from anabolic-androgenic steroids toward growth hormone secretagogues, growth-hormone-releasing hormone analogues and synthetic peptide fragments, marketed as more selective and safer, with clinical evidence drawn almost entirely from therapeutic dosing rather than the supraphysiological and combined protocols used in bodybuilding [s7]. The review flags cardiovascular strain, insulin resistance, dyslipidaemia and psychiatric instability as emerging risks, compounded by an unregulated supply chain in which products are frequently mislabelled or contaminated [s7]. Its central admission is that prevalence in the general and recreational population is unknown, and that this is a critical gap [s7].

The non-cardiac health picture is also being documented. A cross-sectional survey of 60 competitive bodybuilders — 29 men, 31 women — found reduced libido, increased hunger and sleep disturbance in both sexes, frequent binge-eating episodes after competition, menstrual irregularities among women, questionnaire scores indicating potential risk of orthorexia nervosa, and exercise-addiction risk in novice women and advanced men [s8]. Sixty self-selected respondents on an anonymous online questionnaire cannot establish prevalence, and the authors present the work as descriptive [s8].

What to watch

The male study's call was for improved preventive measures at the sport's institutional level [s1]. Whether any federation responds with mandatory pre-competition cardiac evaluation, and whether that response is ever published in a form researchers can audit, is the concrete thing to follow. So is the more basic gap both cohorts expose: with autopsy available in only a handful of cases across nearly 30,000 athletes [s1][s2], the sport still cannot say precisely what is killing its competitors.

Sources

1. [s1] Vecchiato M, Ermolao A, Da Col M, et al. Mortality in male bodybuilding athletes. European Heart Journal, August 2025. https://academic.oup.com/eurheartj/article/46/30/3006/8131432
2. [s2] Vecchiato M, Ermolao A, Zane L, et al. Mortality in female bodybuilding athletes. European Heart Journal, published online 20 October 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12807564/
3. [s3] Vecchiato M, Neunhaeuserer D, Ermolao A. Bodybuilders or bodybreakers: when bigger muscles mean bigger health risks. European Heart Journal, July 2026. https://doi.org/10.1093/eurheartj/ehaf912
4. [s4] Smit DL, Voogel AJ, den Heijer M, de Ronde W. Anabolic Androgenic Steroids Induce Reversible Left Ventricular Hypertrophy and Cardiac Dysfunction. Echocardiography Results of the HAARLEM Study. Frontiers in Reproductive Health, September 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9580689/
5. [s5] 2026 Arnold Classic Results For All Divisions. Fitness Volt, 6 March 2026. https://fitnessvolt.com/2026-arnold-classic-results-all-divisions/
6. [s6] 2025 Mr. Olympia. Wikipedia. https://en.wikipedia.org/wiki/2025_Mr._Olympia
7. [s7] Coutinho LFD, de Oliveira Neves LF, Camilo RP. A new era of doping? Use of peptide and peptide-analog drugs in recreational and professional sport and bodybuilding: a critical review. The Journal of Sports Medicine and Physical Fitness, 25 March 2026. https://doi.org/10.23736/s0022-4707.26.17773-1
8. [s8] Moro F, Cruccolini I, Mauro M, et al. Between Aesthetics and Health: Disordered Eating, Exercise Addiction, and Body Image in Competitive Bodybuilders. Journal of Functional Morphology and Kinesiology, 13 June 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC13301592/