If from PEDs it was more likely HGH and insulin.
Insulin? Interesting. I take it that’s to cut body fat?
I’d say not only that, but the starvation diets they endure on competition weeks, putting themselves on diets that rival concentration camp schedules, using diuretics to dump as much water as possible to achieve the cut look, and, of course the extra body mass imposing the increased burden on the heart, all contribute. They’re not athletes, and don’t enjoy the same health benefits of the cardiovascular work and fitness associated with such people.