Leadership can kill you. At least leadership in high stakes positions.

Nineteen chief executives died in office in 2023, the most since 2010, according to Challenger, Gray & Christmas, which tracks turnover at U.S. companies. The outplacement firm tallied a record 1,914 CEO exits in 2023, which Senior Vice President Andy Challenger partly attributes to the post-pandemic burnout that many execs feel. In a January survey of 600 C-suite executives by the professional network Chief, 37% said avoiding burnout would be a personal challenge this year.

A candid help-wanted ad might go something like this: Company seeks visionary leader to take business to the next level. Incumbent will be paid handsomely but may have fewer years to enjoy earnings because the stress of the role can reduce life expectancy.

Ivan Menezes was a few weeks shy of retiring as CEO when he died last June at age 63. The company said he was hospitalized for stomach ulcers and died after a brief illness. Notable CEOs who suffered fatal heart attacks on the job in the past 20 years include Jim Cantalupo of McDonald’s, Samuel “Skip” Ackerman of Panacos Pharmaceuticals, Jerald Fishman of Analog Devices, and Carolyn Reidy of Simon & Schuster. They ranged in age from 58 to 71.