Eating Chili Peppers Tied to Reduced Risk of Death

Megan Brooks

December 17, 2019

Regular consumption of hot chili peppers was associated with a lower risk of dying from a cardiovascular disease (CVD) cause or any cause in a large study of Italians, independent of CVD risk factors or adherence to a Mediterranean-style diet.

"The epidemiological evidence on chilies' benefit on health is scarce, mainly based on popular folklore; only two prospective studies were available so far," Marialaura Bonaccio, PhD, from the Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy, told | Medscape Cardiology.

The new study, she said, represents "the first time that consumption of chili pepper has been extensively analyzed within a Mediterranean population. We found chili pepper to be beneficial independently from Mediterranean diet."

The study was published online December 16 in the Journal of the American College of Cardiology.

The Moli-sani Study

The longitudinal analysis included 22,811 men and women enrolled in the Moli-sani Study from 2005 to 2010. Using the European Prospective Investigation into Cancer (EPIC) food frequency questionnaire, chili pepper consumption was categorized as none/rare, up to two times per week, two to four times per week, and more than four times per week.

During a mean follow-up of 8.2 years, 1236 people died, including 444 from CVD, 258 from ischemic heart disease/cerebrovascular disease, 482 from cancer, and 310 from other causes.

In the fully adjusted model, compared with people who rarely or never ate chili peppers, their peers who ate chili peppers more than four times weekly had a 23% lower risk of all-cause mortality (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.66 - 0.90) and a 34% lower risk of CVD mortality (HR, 0.66; 95% CI, 0.50 - 0.86), although no cancer death risk reduction was found.

Regular chili pepper consumption was also inversely associated with death from ischemic heart disease (HR, 0.56; 95% CI, 0.35 - 0.87) and cerebrovascular disease (HR, 0.39; 95% CI, 0.2 - 0.75) compared with no or low consumption.

Protection from mortality risk was "independent of the type of diet people followed. In other words, someone can follow the healthy Mediterranean diet, someone else can eat less healthily, but for all of them chili pepper has a protective effect," Bonaccio said in a statement.

The apparent protective effect of eating chili peppers seemed stronger in people without hypertension (P for interaction = .021).

Caveats and Limitations

The exact mechanism(s) between chili pepper's apparent health benefits remain to be elucidated, Bonaccio told | Medscape Cardiology.

"We tested several mechanisms possibly accounting for the associations between chilies and health outcomes; however, established biomarkers (such as inflammation, blood pressure, etc) did not turn out to be on the pathway. More studies are needed to understand the mechanisms through which chili pepper (and its major constituent, capsaicin) are likely to provide health advantages," she explained.

Bonaccio also noted that the information collected in the study does not allow to distinguishing between the type or "heat" of chili peppers consumed and risk reduction. Due to the observational nature of the study, causality can only be suggested and residual confounding or confounding by unmeasured factors cannot be fully ruled out, the researchers note.

Despite the study's limitations, the researchers say their results are in line with the main results of two earlier studies from non-Mediterranean cohorts.

A large study from China found that regular consumption of spicy food lowered the risk of total mortality by 14% and ischemic heart disease death by 22%.

And recent data from the US National Health and Nutrition Examination Survey found that consumption of hot red chili peppers was associated with a 13% reduction in total mortality risk.

J. David Spence, MD, professor of neurology and clinical pharmacology and director of the Stroke Prevention and Atherosclerosis Research Centre in London, Ontario, Canada, weighs in on the results in a linked editorial.

"Should we all begin taking tablets of capsaicin and dousing our food with hot sauce? The history of food supplements suggests that we should wait for randomized trials," Spence writes.

"What appears to be most beneficial is the eating pattern, rather than any one food," he says. "The Mediterranean diet, which is high in whole grains, fruits, vegetables, and legumes, is high in beneficial phytochemicals. Because it is a 'mainly vegetarian diet,' the Mediterranean diet is also low in cholesterol and saturated fat. . . . Thus, adopting the Cretan Mediterranean diet would be much more likely to reduce cardiovascular risk than adding Tabasco sauce (McIlhenny Co., Avery Island, Louisiana) to the unhealthy American diet."

The study was supported by grants from the Italian Ministry of Health, the Italian Association for Cancer Research (AIRC) and BiomarCaRE (Biomarkers for Cardiovascular Risk Assessment in Europe). The study authors have disclosed no relevant financial relationships. Editorialist Spence is a consultant for Amgen and Orphan Technologies, an officer of Vascularis, and has received lecture fees from Bristol-Myers Squibb and Pfizer.

J Am Coll Cardiol. 2019;74:3139-3149. Abstract, Editorial

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