April 8, 2025, 12:07 pm | Read time: 8 minutes

Following the death of bodybuilder and actor Vittorio “Vito” Pirbazari (✝44, “Dogs of Berlin”), who is said to have suffered a heart attack during a training session on the treadmill, the question arises: How can it happen that seemingly fit people die so suddenly from a heart attack? What are the signs that are often overlooked? FITBOOK takes a look at possible causes and early warning signs.

Studies Show More Deposits in Coronary Arteries of Active Athletes

Regular physical activity is known to be a proven method of preventing cardiovascular disease. But could exercise also promote heart events? In fact, there are several studies that point to an increased number of cases of coronary arteriosclerosis — popularly known as vascular calcification — in well-trained male athletes who exercise.

The work of researchers at the Humboldt University of Berlin led by Stefan Möhlenkamp, who demonstrated this connection for marathon runners aged over 50, is considered groundbreaking. Compared to control subjects with the same risk factors, they had increased CAC values.¹ CAC is a marker for arteriosclerosis and therefore an indicator of heart disease. In another study, the most active participants were more likely to have coronary atherosclerotic plaques.² In 2019, researchers also found increased coronary calcification more frequently in very active men compared to less active men.³ Most recently, a study in subjects who already had signs of deposits in the coronary arteries — and an activity level that was roughly equivalent to a daily 6.5-kilometer run — found that their CAC values increased faster compared to less active or even inactive subjects.

Why Do Fit, Young People Also Suffer Heart Attacks?

What is the reason for this? We don’t know exactly yet. Researchers suspect that the increased blood pressure and pulse during sports can lead to a tear in the plaque surface. The body then tries to heal the tear by forming a clot, which in turn blocks the coronary artery, resulting in an acute heart attack, which can lead to ventricular fibrillation and sudden cardiac death.

However, it must also be said that increased coronary arteriosclerosis does not automatically mean a higher risk of heart attack, even if the aforementioned studies show that intensive physical activity can be associated with an increase in coronary artery calcification. Overall, sport reduces the risk of cardiovascular disease. Blood flow is improved, and the arteries remain more elastic, which reduces the risk of high blood pressure and vasoconstriction. Sport also has a beneficial effect on cholesterol and inflammation levels.

Coronary Heart Disease Is the Most Common Cause of Sudden Cardiac Death

On the other hand, it is, of course, also true that just because sport generally improves the elasticity of the arteries, among other things, does not mean that athletes are protected from a heart attack. Therefore, even very fit people should not overlook the possibility of coronary heart disease (CHD)! According to scientific calculations, around five million people in Germany are known to have CHD. And from the age of 35 to 40, coronary heart disease (CHD) is the most common cause of sudden cardiac death at 80 percent — even among athletes.⁴ The most common cause of sudden cardiac death, on the other hand, is a heart attack — which is triggered by coronary heart disease.

Coronary heart disease colloquially refers to the hardening of the blood vessels. “We cardiologists understand this to mean deposits in the coronary arteries, which can ultimately lead to either infarcts or circulatory disorders of the heart,” explains Cologne cardiologist Dr. Christopher Schneeweis in an interview with FITBOOK.

These so-called plaques often do not cause any symptoms at all. The process takes place in our vascular walls without us noticing it. “In the worst case, sudden cardiac death is the first symptom of coronary heart disease,” explains Schneeweis.

In the worst case, this is the chain: plaques that suddenly rupture lead to a blood clot, as a result of which the heart is no longer supplied with oxygen: Heart attack. This, in turn, can trigger cardiac arrhythmia, which, without help, can lead to cardiac arrest and then death within a few minutes.

Heart Attack Does Not Necessarily Announce Itself

“A heart attack doesn’t necessarily announce itself,” explains Schneeweis. Half of the people who suffer a heart attack experience sudden cardiac death. However, not every heart attack automatically leads to cardiac death — the decisive factor is whether there are life-threatening arrhythmias and whether help arrives quickly.

In principle, coronary heart disease (i.e., heart attack) is one of the main causes of sudden cardiac death in athletes over the age of 35. However, there are other causes: “At a younger age, structural heart disease, i.e., myocardial disease or, for example, myocarditis or cardiac arrhythmia, are often the cause,” adds Christopher Schneeweis.

Why Did the “Dogs of Berlin” Star Have a Heart Attack?

We do not know whether the Dogs of Berlin star had a pre-existing condition. According to BILD, Pirbazari is said to have resumed training after a lengthy injury break due to a torn pectoral muscle. He is said to have reported on his physical condition in postings, including expressing optimism that he will be back in good shape by the fall.

FITBOOK is not aware of his risk profile with regard to heart disease. According to the cardiologist, athletes often aren’t either. We also don’t know whether he had any other heart disease. Nor do we know whether any substances were consumed — according to Schneeweis, these can also increase the risk.

Are There Still Early Signs of a Heart Attack?

Common early warning signs of a heart attack include:

• Pain and a feeling of tightness or pressure in the chest
• Paleness and cold sweat
• Burning in the chest
• Pain in the upper abdomen, as well as nausea and vomiting

The latter symptoms, in particular, are rather unspecific and are more common in women with heart attacks. As the heart attack can manifest itself differently in men and women and is more likely to be accompanied by non-specific symptoms such as abdominal pain in women, it remains undetected in them more often and for longer.

What to Do in an Emergency?

Do not ignore these symptoms, and take your body’s warning signs seriously! If you notice signs of a heart attack, some of which can occur hours beforehand in the form of mild chest pain, you should definitely call a doctor. If a heart attack occurs, immediately call emergency services at 911. The faster a heart attack is treated, the lower the risk of consequential damage.

Until the emergency doctor has arrived, place the patient in a gentle position with the upper body elevated. Do not elevate the legs! This relieves the strain on the heart. If unconsciousness with respiratory and cardiac arrest occurs, resuscitation should be started as quickly as possible. In the hospital, the blocked artery can usually be reopened with an intervention (cardiac catheterization) to restore blood flow.

Prospects with Timely Treatment

With prompt treatment, the chances of a successful recovery are high, and depending on the severity of the heart attack, the patient may recover without significant long-term damage. It is crucial to minimize the time before treatment begins. Immediate action is required in the event of a heart attack!

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What Are the Risk Factors for a Heart Attack?

Smoking, obesity, high cholesterol, and high blood pressure increase the risk of a heart attack. Sufficient exercise and a healthy diet should also be ensured. Too much stress can also be a trigger. Age and gender are also important factors: The likelihood of experiencing a heart attack increases with age. Men are more frequently affected and tend to experience heart attacks at a younger age compared to women.

It is important to understand that coronary heart disease is not a disease of old age, but can also manifest itself at an earlier age. For example, in 50 percent of cases, affected men have the event before the age of 60.