The iconic professional wrestler known as The Ultimate Warrior died of a massive heart attack April 8, a new autopsy report shows. The man behind the persona, James Hellwig, was known particularly for his victory over Hulk Hogan at WWE’s WrestleMania VI, where he was crowned WWE Champion. He was 54.

A Future Already Written

Hellwig’s death is hardly the first heart attack professional wrestling has seen. In fact, it’s the leading cause of deaths in the profession. Wrestlers are far more likely to die early than the rest of the general public, and many experts claim it’s the mix of steroids, prescription painkillers, and illegal drugs — used to dull the agony of constant performance, on the road some 300 days out of the year — that has led to so many early deaths.

Hellwig’s heart attack came at age 54. Randy “Macho Man” Savage died at 58. Big Boss Man, aka Raymond Traylor Jr., died at 41. Davey Boy Smith, better known as The British Bulldog, died at 39 — all of them from heart attacks. But they’re not the only ones. USA Today research of medical documents, autopsies, and police reports, shows that between 1997 and 2004, at least 65 wrestlers out of the active 1,000 died in that time. Of those, 25 were heart attacks — an unbelievably high rate for people that young, experts say.

In fact, pro wrestlers have early death rates seven times higher than the general public and are 12 times more likely to die from heart disease, explains Keith Pinckard, a Dallas medical examiner in who’s studied wrestling fatalities. Pinckard has found that it’s no secret why these wrestlers are dying early: Their job all but demands it.

The Demands

Like a lack of sleep for physicians and postal workers’ call to withstand any weather, professional wrestlers need to be strong, or at least muscular. Despite the WWE’s 2007 Talent Wellness Program, which allegedly prohibits the use of performance-enhancing drugs, the truth is that pro wrestlers need to be larger than life. And to get there, they’ll use the easiest means necessary.

The industry, perhaps the United States’ last bastion of performance art, relies on intricate storytelling and boiling mad characters hurling themselves at each other, for the sake of entertainment. Professional football, with its swelling concussion problem, still has only one-twentieth the death rate before age 45 compared to pro wrestling, USA Today discovered. But football has the luxury of finesse, with its nimble quarterbacks and wiry receivers. Pro wrestling is all size, all the time.

The sport itself heavily stresses the body. A larger frame and increased muscle mass will put undue stress on the heart muscle, but the physical toll of pile drivers and body slams can’t help but contort the neck and spinal cord (yes, even if it’s fake). What’s more, wrestlers routinely put themselves at risk for a condition known as “dissection,” or basically where the lining of an artery tears, impeding blood flow. In many wrestlers’ cases, this is from the neck to the brain.

“Hyperextending the head or rotating the head aggressively can separate the inner lining of the artery from the outside wall,” Dr. Andrew L. Carney, former University of Illinois professor and expert in brain health, explained. In some cases, what looks like a heart attack could actually be a classic case of brain stem ischemia: collapse, respiratory arrest, and subsequent cardiac arrest.

Dissection can only be found after death. The famous wrestler Chris Benoit, who died at age 40 and once suffered a broken neck, was found in his autopsy to have the brain of an 85-year-old man with Alzheimer’s.

Comes With The Job

In reality, the profession that purports to be the strongest and toughest is probably the weakest. Mike Lano, a former wrestling manager and promoter, tells USA Today that athletes would commonly bet among each other who would be the next to die.

Day-to-day life in hotel rooms would cause deep and intense paranoia, hallucinations, and psychosis from the constant fatigue mixed with mountains of pain pills. Scott “Raven” Levy reportedly took steroids and 200 pain pills daily before kicking the habit. At the time, it was never a question of “if” you would take steroids to perform, but “how many.”

"It's part of the job," Levy said. "If you want to be a wrestler, you have to be a big guy, and you have to perform in pain. If you choose to do neither, pick another profession."