Chili pepper consumption may reduce CVD, all-cause mortality
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Regular dietary intake of chili peppers conferred lower risk for all-cause and CVD death in Italian adults, independent of CVD risk factors or adherence to a Mediterranean diet, according to research published in the Journal of the American College of Cardiology.
In a cohort of Italian adults from the Molise region of Italy, regular consumption of chili peppers (more than four times per week) was associated with lower all-cause mortality (HR = 0.77; 95% CI, 0.66-0.9) and CVD mortality (HR = 0.66; 95% CI, 0.5-0.86) compared with less frequent or no intake of chili peppers.
Moreover, regular intake of chili peppers was 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 low or no intake, according to the study.
The protective association between chili pepper intake and all-cause and CVD death was stronger in individuals without hypertension than in those with it (P for interaction = .021).
“An interesting fact is that protection from mortality risk was independent of the type of diet people followed,” Marialaura Bonaccio, PhD, epidemiologist at the Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy, said in a press release. “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.”
In other findings, although serum vitamin D had modest attenuating effect on these findings, other known biomarkers for CVD poorly accounted for the observed relationship between chili pepper consumption and all-cause and CVD death.
Chili pepper in Italian culture
“Chili pepper is a fundamental component of our food culture,” Licia Iacoviello, MD, PhD, director of the department of epidemiology and prevention at the IRCCS Neuromed and professor of hygiene and public health at the University of Varese, said in the release. “We see it hanging on Italian balconies, and even depicted in jewels. Over the centuries, beneficial properties of all kinds have been associated with its consumption, mostly on the basis of anecdotes or traditions, if not magic.”
Researchers surveyed 22,811 men and women enrolled in the Moli-sani Study cohort from 2005 to 2010. Chili pepper consumption was estimated by the EPIC Food Frequency Questionnaire. Participants were classified as no or rare consumption, up to two times per week, two to four times per week and more than four times per week. Participants were followed up for a mean of 8.2 years.
“It is important now that research deals with it in a serious way, providing rigor and scientific evidence,” Iacoviello said in the release. “[Now], as already observed in China and in the United States, we know that the various plants of the Capsicum species, although consumed in different ways throughout the world, can exert a protective action toward our health.”
Eating patterns crucial
“What appears to be most beneficial is the eating pattern, rather than any one food. 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,” J. David Spence, CM, MD, professor of neurology and clinical pharmacology and director of the Stroke Prevention and Atherosclerosis Research Centre in London, Ontario, Canada, wrote in a related editorial. “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.” – by Scott Buzby
Disclosures: The authors report no relevant financial disclosures. Spence reports he is a consultant for Amgen and Orphan Technologies, is an officer of Vascularis Inc. and has received lecture fees from Bristol-Myers Squibb and Pfizer.
Perspective
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Erin D. Michos, MD, MHS, FACC, FAHA
Eat more spice, get more life? Being half-Italian myself and married to a Greek, I certainly want this to be true. Chili peppers are a stable of Mediterranean food culture. This latest study from Bonaccio and colleagues found a marked independent 23% reduction in all-cause mortality, 34% reduction in CVD mortality, and a 61% reduction in cerebrovascular mortality for those eating chili peppers more than four times a week compared to those who do not. It seems almost too good to be true.
There are potential biological mechanisms related to anti-inflammatory, antioxidant, and obesity prevention effects. However, nutritional epidemiology studies can be plagued by residual confounding from other social and behavioral factors. People do not eat single foods in isolation, but as part of an overall diet and lifestyle pattern. In this cohort, higher consumption of chili peppers was associated with closer adherence to Mediterranean diet, higher diet quality and greater leisure-time physical activity. While the authors adjusted for a number of lifestyle factors such as energy intake, Mediterranean diet score and physical activity, residual confounding is still a concern in my mind.
The authors tried to explore biological mediators and did not find too much. Despite purported anti-inflammatory effects of the chili pepper, the authors did not find that inflammatory markers such as high-sensitivity C-reactive protein and white blood cell count mediated the associations found. Serum 25(OH)D was identified as a marginal mediator, but serum 25(OH)D itself has been challenged as a causal factor for CVD since vitamin D supplementation has not been shown to reduce CVD events in randomized clinical trials. Rather low 25(OH)D might be a surrogate marker of poorer health status. Also, no dose response was seen, although the authors evaluated frequency per week of chili pepper intake, not total number of chili peppers. The association with mortality was stronger among those without hypertension, but interestingly no significant difference was seen among those who were more or less adherent to Mediterranean diet.
In my mind, I am not going to make a concerted effort to counsel patients to newly start increasing their intake of spicy foods based on this observational data. There has been previous discrepancy between favorable observational data of antioxidants, vitamin D, and other supplements followed by randomized clinical trials which failed to confirm benefit. I think we need a trial before we get too “fired” up.
What do I tell my patients? We should focus on healthy eating patterns rather than single food items. People do not eat food in isolation. The Mediterranean diet is considered to be one of serval healthy dietary patterns because it is enriched in fruits, vegetables, legumes, whole grains and nuts, with moderate consumption of unsaturated fats like vegetable oils and fish, and is generally low in saturated fats. This is a type of eating pattern that aligns with the ACC/American Heart Association Primary Prevention of Cardiovascular Disease guidelines. There is also the “Mediterranean lifestyle” of incorporating more leisure-time physical activity in one’s day. So sure, if one likes chili peppers, these data would support continuing that consumption. But more gains can be made for CVD prevention by following a healthy lifestyle throughout one’s lifespan rather than just adding chili peppers to an unhealthy “American” type diet.
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