Rich Piana died on August 25, 2017, after spending two weeks in an induced coma following a sudden collapse at his home. The immediate cause of his collapse was cardiac arrest, during which his heart was not beating properly, and he suffered brain damage due to lack of oxygen
. An autopsy revealed that Piana had "significant heart disease," including an enlarged heart (cardiomegaly) and coronary atherosclerosis (hardening of the arteries). His heart and liver weighed over twice the average amount for an adult male, which are known side effects of long-term steroid and hormone use. Twenty bottles of testosterone were reportedly found in his home, and he was open about using anabolic steroids and insulin
. However, the official cause of death was ruled as "unknown" because no toxicology analysis was performed. The hospital discarded the specimens needed for toxicology testing, preventing investigators from determining whether drugs or supplements in his system contributed to his death. This lack of toxicology data has led to speculation and conspiracy theories, but no conclusive evidence links drug use directly to his death
. In summary, Rich Piana died primarily due to complications related to significant heart disease, likely exacerbated by his steroid use, but the exact cause remains officially undetermined due to missing toxicology information
