The participation of women in bodybuilding has grown substantially, but the risks of sudden cardiac death (SCD) and overall mortality in this population remain incompletely understood. A large longitudinal study, published in the European Heart Journal, assesses SCD and all-cause mortality among female bodybuilders and compares findings with male bodybuilders from the same period.
Methods
Researchers analyzed data from 2005 to 2020, categorizing female athletes into Women’s Bodybuilding, Women’s Physique, and Figure divisions. Master athletes were defined as those aged 35 years or older. Death rates were calculated per 100,000 athlete-years (AYs). Subgroups included junior, open, master, division type, amateur, and professional statuses to estimate mortality and SCD incidences.
Key findings
Over 16 years, 9,447 women bodybuilders were followed, with 32 deaths and a mean age at death of about 43 years. North American athletes accounted for 44% of deaths. Of the 32 deaths, 24 had a specified cause: five non-sudden, 19 sudden. Seven were traumatic and twelve non-traumatic. Ten deaths were classified as SCDs (about 31% of total deaths), with a mean age around 42 years. Suicide or homicide accounted for roughly 13% of deaths, higher than in male bodybuilders, suggesting gender-specific psychosocial stressors and vulnerability, though causality cannot be established.
SCD remained the leading cause of death in both sexes, with the highest SCD incidence in the Women’s Bodybuilding division. Professional athletes showed markedly higher SCD rates (53.98 per 100,000 AYs) than amateurs (2.48 per 100,000 AYs). Across the overall female cohort, all-cause mortality was 33.51 per 100,000 AYs, while SCD was 10.47 per 100,000 AYs.
Comparisons with male bodybuilders
When contrasted with male bodybuilders, women exhibited lower all-cause mortality and lower SCD incidence, though trends were similar. All-cause mortality IRR was 0.53, and SCD IRR was 0.43, indicating roughly half or less risk in women for these outcomes. Among professionals, the SCD IRR was 0.28. Autopsy data were limited, with only two deaths among professional women having autopsy results showing a normal heart and myocarditis, respectively. By contrast, male bodybuilders often show heart abnormalities such as left ventricular hypertrophy, suggesting potential sex differences in cardiac adaptation to intense training.
Risk determinants and context
Common risk factors identified in male cohorts—extreme strength training, rapid weight cutting, and use of performance-enhancing drugs (PEDs)—likely apply to female athletes as well, though the study could not quantify exact contributions. Toxicology confirmed PED use in four cases. Notably, one junior athlete died of trauma, while nine master athletes died (three of which were SCDs) with a mean death age around 52 years. Seven deaths occurred within a year of the latest competition, and SCDs in this group happened around events. Among currently competing athletes, all-cause mortality and SCD rates were 40.87 and 11.68 per 100,000 AYs, respectively.
Limitations
The cause of death remained undetermined in 25% of cases. The study relied on publicly available competition registries without adjustment for potential confounders, limiting cross-study comparability and causal inferences about specific risk factors.
Conclusions
This long-term study provides the first quantitative assessment of SCD and all-cause mortality in a large cohort of female bodybuilders. SCD was the leading cause of death, consistent with findings in male bodybuilders, but overall mortality was lower in women. Methodological differences and incomplete cause data warrant cautious interpretation. The findings underscore the need for ongoing surveillance, safer training and competition practices, and more research into sex-specific cardiac adaptations in high-intensity athletic populations.
Related topics
