Chili Pepper Consumption Linked to Better Midlife Survival

Marlene Busko

November 23, 2020

In a meta-analysis of four geographically diverse observational studies, a higher intake of any type of chili pepper was associated with a lower rate of death from cardiovascular disease, cancer, or all causes, during a 7- to 19-year follow-up in mainly middle-aged adults.

Results showed a 26%, 23%, and 25% relative reduction of death from cardiovascular disease, cancer, and all causes, respectively, for the highest vs lowest or no consumption of chili peppers.

Bo Xu, MD, presented these findings at the virtual American Heart Association (AHA) 2020 Scientific Sessions.

The word "associated" is important, stressed Xu, from Cleveland Clinic's Heart, Vascular & Thoracic Institute, Cleveland, Ohio, in an interview with | Medscape Cardiology.

The meta-analysis "definitely does not by any means prove a causal relationship" because none of the four studies in the meta-analysis were randomized controlled trials, he emphasized.

Rather, these were prospective, observational, cohort studies, and "none were really powered to answer the question of which type of chili pepper, how much," and how frequently people should consume it to gain potential health benefits, he said.  

"As a cardiologist, the main message that I want to highlight is not that one should go out and just buy chili pepper and eat it every day," Xu said, as if it would cancel out the effect of an unhealthy lifestyle. Rather, Xu promotes a Mediterranean diet for his patients.

"I wouldn't ask anyone to start eating [chili peppers] now," he said, "but next time, if they see it and they didn't like it before, they can try a bit of chili pepper."

Invited to comment, J. David Spence, MD, who wrote an editorial about one of the studies that was included in the meta-analysis by Bonaccio et al, also stressed that the findings are "about association, not causation."

"I have concerns" and "some doubts" that the chili peppers account for the reduced death during the studies, said Spence, director of Stroke Prevention and Atherosclerosis Research and professor of neurology and clinical pharmacology at Western University in London, Ontario, Canada.

The take-away message from this meta-analysis remains the same as in his editorial, he told | Medscape Cardiology. That is, "sprinkling some Tabasco sauce on the extremely unhealthy US diet is not the answer." Instead, "following the new guidelines that recommend a more plant-based diet like the Cretan Mediterranean diet would achieve far more."

Spence pointed out the Heart Disease and Stroke Statistics–2015 Update report from the AHA by Mozaffarian et al published in Circulation highlights how few Americans follow an ideal "heart heathy" eating plan.

The report found that of seven measures of cardiovascular health, diet was worse than measures for smoking, body mass index, physical activity, total cholesterol, blood pressure, and fasting plasma glucose.

Specifically, among 20- to 49-year-old Americans, only 0.6% consumed an (ideal) healthy diet, 21.9% consumed a somewhat healthy (intermediate) diet, and the rest had a poor diet — based on the 2011 to 2012 National Health and Nutrition Examination Survey (NHANES).

Among adults age 50 and older, only 0.4% consumed an ideal diet and 34.3% consumed an intermediate diet, and diets among children aged 12 to 19 were even worse; only 0.1% ate a healthy diet and 8.3% had a somewhat healthy diet.

"What appears to be most beneficial is the eating pattern rather than any one food," Spence said.   

Hot Pepper Use in the US, China, Iran, and Italy

Animal studies and small studies in humans have shown that capsaicin, the active ingredient in chili peppers, has anti-inflammatory, antioxidant, anti-cancer, and blood regulation effects, said Xu.

The researchers identified four observational studies of consumption of chili peppers that had data for death from all causes, cardiovascular disease, and cancer, in more than 570,000 participants:

  • A study by Bonaccio et al of participants in the Moli-sani study in Italy

  • A study by Chopan et al of adult participants in NHANES III, surveyed from 1988 to 1994, in the US

  • A study by Hashemian et al of participants in the Golestan Cohort study in Iran

  • A study by Lv and colleagues of participants in the China Kadoorie Biobank

The type and frequency of consumption of chili peppers varied greatly.

In the US study, the participants were 18 to 90 years old, with a mean age of about 45, and were followed for almost two decades. In the other three studies, the participants were 30 to 79 years old, with a mean age of about 52, and were followed for roughly 8 years.

Table. Patient Characteristics of the Four Studies in the Meta-analysis

First Author, Country, Year Total Cohort Mean Age, Range Follow-up, Years Type of Peppers Chili Pepper Consumers; Frequency
Bonaccio, Italy, 2019 22,811 55 (35) 8.2 Chili pepper 15,122; up to 2 times/wk to >4 times/wk
Chopan, US, 2017 16,179 45 (18-90) 18.9 Hot red chili pepper 4107; 1/month
Hashemian, Iran, 2019 44,398 52.5 (40-75) 11 Black or chili pepper 31,071; 0
Lv, China, 2015 487,375 52 (30-79) 7.2 Chili pepper (fresh, dried, sauce, or oil) 208,884; 1/week


In the pooled data analysis, compared with individuals who rarely or never ate chili peppers, those who ate them up to more than four times per week had a lower risk ratio (RR) of death from all causes (0.75), cardiovascular disease (0.74), and cancer (0.76), during follow-up, after adjusting for multiple characteristics.

American Heart Association (AHA) 2020 Scientific Sessions: Abstract P1036 Presented November 13, 2020.

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