At the Other End of the Spectrum: Bigorexia as an Emerging Cardiovascular Phenotype in Adolescents

Bigorexia, or muscle dysmorphia, is an increasingly prevalent body image disorder among adolescents characterized by an excessive drive for muscularity. This behavioral phenotype is associated with a cluster of lifestyle exposures—including anabolic androgenic steroid use, high energy drink consumption, and excessive high-protein diets—that may collectively promote early cardiovascular injury. Emerging evidence suggests that these factors contribute to a distinct cardiovascular phenotype marked by premature atherosclerosis, pathological left ventricular hypertrophy, and increased arrhythmogenic risk. Despite growing recognition of bigorexia as a psychological condition, its cardiovascular implications remain underexplored. This review synthesizes current evidence linking bigorexia-related behaviors to cardiovascular dysfunction and proposes a conceptual framework for this emerging phenotype, highlighting the need for early recognition, risk stratification, and targeted preventive strategies.