A competitor’s death onstage in England and new research documenting dozens of sudden cardiac deaths are putting pressure on a sport that rewards physiques no judge can see inside.
Mateusz Chmura collapsed onstage on October 18 while competing in the Classic Bodybuilding Medium category at the Physical Culture Association’s British Finals in Telford, England, one day before his 34th birthday. Medical personnel treated him at the venue, and he was taken to a hospital, where he died, The Independent reported. The Polish bodybuilder from Wakefield had entered his first competition just two weeks earlier, finishing second, and had married his wife, Patrycja, two months before. The PCA has said his cause of death has not been established, and there is no evidence he used performance-enhancing drugs. His death still lands in a sport where success is measured by a body judged entirely from the outside, at a moment when researchers are documenting what can happen on the inside.
The largest study of the question, published in the European Heart Journal in May 2025, tracked 20,286 men who competed in International Federation of Bodybuilding and Fitness events between 2005 and 2020. Across roughly 190,000 athlete-years, researchers identified 121 deaths, including 73 sudden deaths, 46 of them attributed to sudden cardiac death. Professional competitors carried about 5.2 times the risk of sudden cardiac death seen among amateurs. Eleven sudden cardiac deaths struck athletes who had competed within the prior year, at an average age of about 35. Where autopsies were available, they frequently found enlarged hearts with thickened muscular walls. The peer-reviewed study documents an association rather than a cause. It could not separate the roles of drugs, underlying conditions and other risks in individual cases, and it relied partly on public mortality records that can be incomplete.
Women appear in the data too. A separate European Heart Journal study published in October 2025 followed 9,447women in bodybuilding-related divisions over the same period and found 32 deaths, including 10 sudden cardiac deaths, with higher risk among professionals. Women’s divisions vary widely in how much muscularity they reward, so the findings on female competitors don’t mean their risks match men’s. They do undercut the assumption that cardiac danger is confined to the enormous physiques of men’s open bodybuilding.
Judged From the Outside
Bodybuilding scores muscularity, symmetry, conditioning and proportion rather than what a body can lift or how well it performs, and that scoring system shapes the risk. Low body fat and sharp definition reveal nothing about blood pressure, cholesterol, kidney health or heart function. A competitor can look like the healthiest person in the room while carrying problems no judge can see. Reaching the elite look can require months of energy restriction, punishing training, manipulation of fluid balance before a show and, for some athletes, drugs used without medical supervision. Ordinary resistance training builds strength, mobility and metabolic health, and the hazard sits in the gap between that and what the stage now rewards.
Anabolic-androgenic steroids speed muscle growth and recovery. Nonmedical use at doses far above physiological levels has been linked to unfavorable cholesterol changes, hypertension, impaired cardiac function and serious cardiovascular events. Diuretics used to shed water before competition can cause dehydration and potassium imbalances that trigger dangerous heart rhythms. Insulin misuse can cause severe hypoglycemia, and combining several substances makes their effects harder to predict. Supply adds to the danger. Athletes may buy from unregulated sellers, follow coaches with no medical training, or take products sold as peptides or research chemicals whose contents are hard to verify, the same gray market at issue in Washington’s push for a legal peptide market. After Chmura’s death, The Times reported that medical professionals warned about extreme dehydration, unregulated substances and thin oversight in the sport. None of that explains his collapse, and until an official cause is established, tying it to any substance or preparation practice would be speculation.
New research sharpens the picture for long-term users. A longitudinal study of male strength athletes, published October 12 in the European Heart Journal – Cardiovascular Imaging, found that those who kept using anabolic steroids showed persistent thickening of the left ventricular wall, weaker pumping function and a heart less able to relax between beats, even as their reported doses fell. Six of the 35 continued users, about 17%, had severely reduced pumping function. Participants who stopped saw their heart structure and function improve. The sample was small and not limited to competitive bodybuilders, so it can’t predict any one athlete’s outcome. Still, it challenges the belief that cutting the dose cuts the risk, and it suggests quitting can help the heart recover.
The Business of Getting Bigger
The physique is also a product. Competitive success can bring sponsorships, online coaching clients, personal-training businesses and social media deals, which turns appearance into income and makes the pressure to keep growing a financial one. Dramatic transformations draw followers and sell programs and supplements, while the genetics, years of preparation, possible drug use and health costs behind them stay offscreen. Audiences chase the finished image without that context, the same feed-driven pattern behind why women keep risking their lives for BBL surgery. Federations, coaches and sponsors don’t make any individual athlete’s medical decisions. They do sit inside the incentive structure that rewards ever more extreme results.
Who Is Responsible for Athlete Safety
The PCA said paramedics, ambulance crews and other medical staff responded when Chmura collapsed. Organizers paused the event while he was treated, then resumed it after talking with athletes, before learning he had died. The association offered condolences to his family, thanked those who helped and said speculation about the cause would be inappropriate. Emergency care can only respond once a crisis has started, while prevention has to happen before a competitor steps onstage. The researchers behind the mortality studies have called for medical evaluations, cardiovascular education and stronger doping prevention. But bodybuilding is a patchwork of professional and amateur federations with different rules and resources, so the protections at one show may not exist at the next.
The gaps are specific enough to name. Federations could require cardiovascular screening, at least for competitors with known risk factors or symptoms. They could set minimum standards for medical staff and emergency equipment at events. Coaches could be trained to treat dizziness or chest discomfort during prep as a reason to stop, and athletes could be taught how dehydration and diuretics affect the heart. No screening program catches every sudden cardiac event, and each requirement carries costs that smaller organizations would feel most. Under the current arrangement, though, athletes carry nearly all of the medical risk while the rewards spread across a much wider market.
Chmura’s family is mourning a husband who died a day before his birthday, and his medical history should not be used to fill gaps in the evidence. The evidence about the sport itself is harder to set aside. Peer-reviewed studies now document sudden cardiac deaths among both men and women. Federations that rely on event medics alone will find that position harder to defend. If organizers don’t adopt pre-competition screening first, the push for it is likely to come from outside the sport, from venues, insurers and regulators.