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Chili peppers may reduce the risk of cardiovascular disease

A recently published paper describes how regular consumption of hot chili peppers may decrease overall mortality risk plus decrease risks for cardiovascular events. So pour your favorite hot sauce (I have several that I love) on your pancakes and throw extra habañero peppers into your favorite meals.

I’ve written previously that consuming chili peppers may also reduce cognitive decline from dementia and Alzheimer’s disease.

Before you decide to take the ghost pepper challenge with 1 million Scoville units every day of the week, let’s take a step back and look at the research that has been published that may show that chili peppers may be good for cardiovascular health.

No, this article isn’t about these Red Hot Chili Peppers.

Chili peppers and cardiovascular health paper

In a paper published in the Journal of the American College of Cardiology, Marialaura Bonaccio, Ph.D., and colleagues examined the effects of a typical Meditteranean diet that includes chili peppers on mortality and overall health. This cohort study included 22,811 men and women enrolled in the Moli-sani Study.

Typical of these types of studies, consumption of chili peppers was determined by a diary in which the participants indicated their consumption of the food. The researchers then categorized the groups as none/rare consumption, up to 2 times/week, >2 to ≤4 times/week, and >4 times/week.

The results were interesting:

  • Individuals who ate chili peppers regularly (>2 times per week) had a lower mortality of over 8.2 years compared to individuals who did not eat them. This was observed after adjusting for age, sex, and caloric intake confounders.
  • Individuals who regularly consumed chili peppers, compared to those who didn’t, revealed an all-cause mortality hazard ratio (HR) of 0.77. This means that those who regularly consumed chili peppers had an approximately 23% lower risk of death from all causes.
  • The chili peppers group had a 34% reduction in risk of cardiovascular disease (CVD) mortality.
  • The group had a 44% reduction in risk of ischemic heart disease mortality.
  • The group had a 61% reduction in risk of cerebrovascular mortality.
  • The study showed no reduction of risk for all cancers in those who regularly consumed chili peppers.

The researchers also found that the lower risk of all-cause and cardiovascular mortality was independent of other CVD risk factors or adherence to a Mediterranean diet.

These results coincide with two other studies on spicy food:

  • A 2015 Chinese study concluded that eating spicy food daily was linked to a 14% reduction in total mortality and a 22% reduction in ischemic heart disease mortality.
  • A 2017 analysis of the US National Health and Nutrition Examination Survey showed a 13% drop in total mortality associated with the consumption of chili peppers.

As I’ve written before, one of the critical steps in determining whether correlation may be causation is to propose a biologically plausible mechanism of action. The authors stated:

Health benefits of chili peppers have been ascribed to capsaicin, its major pungent compound, which has been observed to favorably improve cardiovascular function and metabolic regulation in experimental and population studies. In addition to its anti-inflammatory and analgesic properties and atheroprotective effects, capsaicin reportedly induces apoptosis of the tumor cells.

It does seem plausible.

It’s about these red hot chili peppers.

Critique of the chili peppers and cardiovascular health study

As I’ve written before, nutritional studies aren’t as conclusive as other types of epidemiological studies. In fact, a lot of nutrition research is just plain bad. I don’t think we should make nutritional decisions based on one-off studies.

One of the major flaws with this type of epidemiological study is that it requires a diary for the consumption of chili peppers. Let’s look at epidemiological studies for vaccines, which are quite powerful.

Those studies rely upon medical records – an individual receives a vaccine, and researchers can track the medical record to get medical facts regarding the safety and effectiveness of the vaccine. It’s very clear and is almost binary in approach – we know a vaccine is given, then we observe whether an event happens after it is medically diagnosed.

On the other hand, this nutritional study relies upon the memory and accuracy of participants to include how much or whether they consumed chili peppers. Then the researchers have to wait years to observe an effect. This memory can be highly biased or incorrect.

In an accompanying editorial in the Journal of the American College of Cardiology, J David Spence, MD, of the Stroke Prevention and Atherosclerosis Research Centre in London, Ontario, Canada, urged caution in interpreting these results:

“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,” Dr. Spence wrote. He cited a 2018 meta-analysis showing that only folic acid and vitamin B complex supplements can be tied to reduced CVD or stroke risk.

Dr Spence continue:

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. As the fat intake is high (40% of calories from fat, mainly olive oil), the diet also has a low glycemic index.

Thus, adopting the Cretan Mediterranean diet would be much more likely to reduce cardiovascular risk than adding Tabasco sauce to the unhealthy American diet.


Although Bonaccio et al. attempted to remove the Mediterranean diet as a confounder, it is very possible that someone who used chili peppers regularly is just coincidental to consuming a regular healthy diet.

Moreover, despite the participants indicating whether they consumed chili peppers, it is entirely plausible that those peppers are included in the cooking of a regular Mediterranean diet, so they would never be included in the data.

On the other hand, although I am not overwhelmingly convinced by this study, it is designed very well and, at a minimum, shows some very intriguing results from consuming chili peppers in one’s diet.

In addition, this study continues to show the benefits of a Mediterranean diet above and beyond the inclusion of chili peppers.



Michael Simpson

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