Higher Chili Pepper Consumption Linked to Fewer CVD Deaths

In what authors say is the first large study of its kind, new research documents an inverse association between chili pepper consumption and the risk of ischemic heart disease, cerebrovascular disease, as well as death from other causes. The findings, this time focusing on an Italian population already likely to be eating a healthy diet, confirm those of other cohort studies conducted in other regions, they say.

“Our study reveals that the health benefits associated with chili pepper intake are independent of the overall quality of the diet, as measured by a traditional Mediterranean diet, thus suggesting an  independent effect of chili pepper toward mortality risk,” write Marialaura Bonaccio, PhD (IRCCS Neuromed, Pozzilli, Italy), and colleagues in the Journal of the American College of Cardiology.

In their examination of data on 22,811 men and women enrolled in the Moli-sani Study, Bonaccio and colleagues found that all-cause mortality was 23% lower among those who consumed chili pepper four or more times per week compared with those who reported not eating the spice at all or rarely eating it.

Commenting on the research for TCTMD, Andrew M. Freeman, MD (National Jewish Health, Denver, CO), said the fact that the study population had a high rate of adherence with a Mediterranean diet makes it difficult to determine if spicy food is responsible for the survival benefit or if people who consume those foods have an inherently healthier eating style.  

“Outcomes overall are better when people eat Mediterranean-type foods regularly because they provide necessary nutrients and create antioxidant-rich and anti-inflammatory-rich environments. But is it the actual chili peppers, or is it everything else? It's very hard to know that from this study,” Freeman said.

Broad Range of Mortality Reductions Seen

The Moli-sani Study is comprised of men and women age 35 years and older living in Molise, a southern Mediterranean region of Italy. It began recruitment in 2005 and aims to evaluate environmental, genetic, and biomolecular risk factors associated with chronic degenerative diseases. Participants completed food questionnaires prior to enrollment that included information on consumption of spices such as garlic, parsley, black pepper, chili, and sweet pepper.

Approximately 25% of participants reported eating chili pepper four or more times per week. Compared with those who reported no or rare consumption, regular chili pepper eaters were more likely to be men, slightly older, and with higher educational level and occupation status. They also had higher prevalence of CVD risk factors and history of CVD, but greater leisure-time physical activity.

The regular chili pepper consumers were more likely than those with no or rare chili pepper intake to closely adhere to a Mediterranean-style diet of fruits and nuts, vegetables, legumes, fish, cereals, and healthy fats. They also tended to consume other spices more regularly and have a higher diet quality as measured by polyphenol and antioxidant content. Routine eaters of chili pepper tended to have higher levels of blood lipids and blood glucose, higher body mass index, and slightly higher blood leukocyte counts. There was no difference in C-reactive protein, though, compared with the no/rare chili pepper group.

I'm a big fan of people eating plants, however they come. If they like them hot or spicy, this is obviously some data suggesting that's a good thing. Andrew M. Freeman

In addition to lower all-cause mortality, regular consumption of chili peppers was associated with lower risk of CVD mortality (HR 0.66; 95% CI 0.50-0.86), ischemic heart disease (HR 0.56; 95% CI 0.35-0.87), and cerebrovascular death (HR 0.39; 95% CI 0.20-0.75) over a median follow-up of 8.2 years. Although a downward trend in death from cancer also was seen, the difference was not significant.

Eating sweet peppers in particular, as opposed to not eating them or rarely eating them, was linked to lower total and ischemic heart disease death but not to cerebrovascular mortality.

Bonaccio and colleagues were unable to determine a dose-response relationship between the amount of chili pepper consumed and the extent of the health benefits. They suggest that the effect is likely an all-or-nothing situation, where the advantage lies in consuming chili peppers as opposed to not consuming them, and that “minor dietary changes, such as adding chilies to usual diet, could be valuable measures for improving health, especially cardiovascular health, independent of overall diet quality.”

Capsaicin and Eating Patterns

In an editorial accompanying the study, J. David Spence, CM, MD (Stroke Prevention and Atherosclerosis Research Centre, Ontario, Canada), notes that the capsaicin in chili peppers increases browning of fat and reduces insulin resistance, both of which may explain the biological mechanisms behind the effect on mortality. Studies have shown that capsaicin has antiplatelet and anticoagulant activity, reduces low-density lipoprotein oxidation, and improves endothelial function, Spence notes.

Although the literature with regard to chili pepper consumption and mortality is sparse, Spence says the Moli-sani findings are in agreement with data from China and also from a 2017 NHANES study, but points out the magnitude of the reduction in mortality among the Italian participants is greater. The factor that may be responsible for that is also the reason Spence says people should not start taking capsaicin supplements or liberally dousing their food in hot sauce.

“What appears to be most beneficial is the eating pattern, rather than any one food,” he writes, adding that adopting a Mediterranean style of eating is more likely to reduce cardiovascular risk than adding [hot sauce] to the unhealthy American diet.

To TCTMD, Freeman agreed that he prefers not to recommend specific foods to patients.

“I'm a big fan of people eating plants, however they come. If they like them hot or spicy, this is obviously some data suggesting that's a good thing,” he observed. “But it certainly makes me savor—no pun intended—some additional research in this area.”