Image source, Getty Images
Earlier this month, Miles Ararujo shared a photo from his gym on social media. He frequently posted such pictures.
In that post, he showcased his sculpted physique, which established him as a professional bodybuilder and a fitness influencer with thousands of followers.
Ararujo’s muscular arms in a red t-shirt looked like those of a superhero.
However, just hours later, in his home in Bahia state in northeastern Brazil, 35-year-old Ararujo suffered a sudden health setback and passed away.
The official cause of his death has not yet been confirmed. He is among several bodybuilders who have died suddenly in recent years.
At the end of May, Gabriel Ganlo, a renowned young Brazilian bodybuilder aged 22, died from sudden cardiac death. Earlier, two other Brazilian bodybuilders in their 30s and 40s died from heart-related conditions, one during a competition.
Similar incidents have occurred internationally as well. American bodybuilder Dallas McCarver died at age 26 in 2017, and German fitness influencer and bodybuilder Joe Lindner passed away in 2023 at the age of 30.
This raises the question: why do some bodybuilders who appear strong, healthy, and fit abruptly die at a relatively young age?
Risks
Image source, Maddie Meyer/Getty Images
A 2025 study has clearly highlighted the risks associated with competitive bodybuilding. The research analyzed nearly 20,000 amateur and professional bodybuilders who participated in international competitions held by the sport’s governing body from 2005 to 2020.
Published in the ‘European Heart Journal,’ the study reported that professional bodybuilders have a fivefold greater risk of sudden cardiac death compared to amateur athletes. Sudden cardiac death refers to an unexpected heart stoppage.
This event is generally rare among healthy young individuals and typically occurs due to underlying heart or vascular diseases.
The study identified 121 deaths, 46 of which were due to sudden cardiac arrest.
The average age of deceased individuals was 45 years, while the average death age among active competitors was only 34.7 years.
Dr. Marco Vicciato of the University of Padua in Italy, the lead author of the study, explains that fatalities among bodybuilders may stem from various causes including excessive use of performance-enhancing drugs, intense training for rapid weight loss, and heavy weightlifting routines.
Another 2025 study published in ‘Circulation’ involved Danish researchers monitoring 1,189 men using anabolic steroids for 11 years, comparing them to 60,000 other men.
The research found that steroid users had approximately nine times higher chances of developing cardiomyopathy—a disease weakening the heart muscle—three times greater risk of heart attack, and more than triple the risk of heart failure.
Other health issues linked to steroids include reduced sperm count, sexual dysfunction, elevated blood pressure, accelerated artery plaque buildup, and structural heart changes.
Impact on Heart Size
The European Heart Journal study also reviewed postmortem reports of deceased bodybuilders.
In many cases, the heart was abnormally large, which disrupts normal heart rhythm and function.
Several young bodybuilders who died early showed massively enlarged hearts during autopsy.
One notable case was Dallas McCarver, who died in 2017 at age 26. His autopsy revealed a heart weighing 833 grams, more than twice the weight of a typical adult male heart.
Image source, Bispo & Zago, 2024, Arquivos Brasileiros de Cardiologia (CC BY)
A 2022 study of postmortem reports on American bodybuilders found their hearts weigh about 74% more than normal, with left ventricular walls up to 125% thicker than expected.
Another investigation of forensic reports on anabolic steroid-using bodybuilders from Italy and Spain revealed many young athletes had enlarged hearts, excessively thick heart muscles, and advanced coronary artery disease.
A 24-year-old bodybuilder showed coronary artery issues exceeding 75%, despite no family history of heart disease.
Endocrinologist and sports physician Dr. Clayton Macedo says, “The heart is just another muscle of the body.”
“I often say I can estimate a person’s heart size by looking at their arm muscles because when muscles grow so does the heart.”
Even without steroids, intense weightlifting can enlarge the heart.
However, Dr. Luiz Eduardo Fontelles Ritlle, president of the Brazilian Cardiology Society, explains that exercise combined with anabolic steroid use not only enlarges the heart but may also impair its pumping ability.
According to him, “This condition causes the heart to stiffen and eventually fail to function properly. In such cases, treatment cannot restore the heart to its original state.”
But in some cases, thickening of the heart muscle may also be hereditary.
Dr. Ritlle notes, “This is still not fully understood.”
There Is No Safe Way to Use Anabolic Steroids
Image source, Rodrigo Góes
Former bodybuilder Rodrigo Góes said he competed without using steroids for 30 years before deciding to start “cycling” steroids under medical supervision.
“Cycling” refers to taking anabolic steroids for a few weeks and then allowing the body time to return to normal.
Góes explains, “It has a profound impact on the body.”
“Muscle grows faster than naturally, body fat decreases, and muscles recover more quickly. It’s tempting.”
Image source, Rodrigo Góes
He stated that even under medical supervision, steroids cause side effects such as hair loss, stress, sleep disturbances, excessive night sweating, and more seriously psychological effects.
He is currently campaigning against steroid abuse.
He said, “There is no completely safe way to use anabolic steroids. Doctors can only manage the effects, but harm is inevitable.”
“I Can Estimate by Simply Looking at Someone’s Arm”
In Brazil, there are no official death statistics related to anabolic steroids. Many other countries also do not list steroid use as a cause of death or health issues.
Deaths are often categorized under direct causes such as heart attacks, strokes, or cardiomyopathies, with performance-enhancing drugs rarely mentioned.
Forensic doctors note that steroids closely resemble hormones naturally produced by the body, making postmortem detection challenging.
Because of these factors, it’s difficult to determine precisely how many deaths are truly linked to performance-enhancing drugs.
Dr. Macedo shares, “I work daily with such patients.”
“Just by looking at someone’s biceps, I can infer many things. Unfortunately, when someone has unusually large biceps, it usually indicates their heart is already affected or under strain. Mostly, they have to face the real consequences.”
Additional reporting: Luis Barucho
