Regular chili pepper consumption associated with lower risk of total and CVD death

Chili Pepper Consumption and Mortality in Italian Adults

Literature - Bonaccio M, Di Castelnuovo A, Costanzo S et al., - J Am Coll Cardiol 2019, DOI: 10.1016/j.jacc.2019.09.068

Introduction and methods

Chili peppers, which belong to the genus Capsicum, are frequently used in traditional dishes from southern Italian regions. Chili peppers contain capsaicin, which has been observed to improve CV function and metabolic regulation [1]. Capsaicin also has anti-inflammatory and analgesic properties and atheroprotective effects [2]. Studies in humans showed that chili pepper consumption facilitates weight loss and is associated with lower incidence of overweight and obesity [3,4]. Dietary capsaicin also prevents microbial dysbiosis, gut barrier dysfunction and chronic low-grade inflammation in animal studies [5]. Two population studies from China [6] and the United States [7] showed an association between regular chili pepper intake and lower mortality risk. However, no epidemiological investigation on the association between chili pepper intake and CVD or total mortality was so far available from a European cohort.

This observational study aimed to prospectively estimate the association between chili pepper intake with total and cause-specific mortality in a large Mediterranean population. In addition, established biomarkers of CV risk were studied to examine a possible biological mechanism through which chili pepper consumption may provide health benefits, and whether inclusion of chili pepper would improve risk prediction associated with a traditional Mediterranean Diet Score (MDS). The study used data from 22,811 individuals from the Moli-sani Study, which enrolled men and women (≥35 years of age) randomly recruited from the general population of Molise, a southern region in Italy [8]. The median follow-up was 8.2 years. Food intake during the year before enrollment was assessed by the EPIC (European Prospective Investigation Into Cancer) Food Frequency Questionnaire validated and adapted to the Italian population [9]. Chili pepper intake was categorized as none/rare consumption, up to 2 times/week, >2 to 4 times/week, and >4 times/week. Established biomarkers of CVD risk that were measured to assess a possible underlying biological mechanism, included serum lipids (total cholesterol, HDL-c, triglycerides), blood glucose, CRP, NT-proBNP, hsTnI, ApoA, ApoB100, Lp(a), cystatin C, creatinine, insulin, C-peptide and serum vitamin D. Adherence to the traditional Mediterranean diet was assessed through the MDS [10].

Main results

  • Regular consumption (>4 times/week) of chili peppers was associated with lower risk of all-cause mortality in comparison to non/rare intake in a fully adjusted model (HR: 0.77, 95% CI: 0.66 to 0.90).
  • Risk of CVD mortality was reduced in regular consumers, in comparison to individuals reporting none/rare chili pepper intake (HR: 0.66, 95% CI: 0.50 to 0.86).
  • Regular intake was associated with lower risk of ischemic heart disease (HR: 0.56, 95% CI: 0.35 to 0.87) and cerebrovascular death (HR: 0.39, 95% CI: 0.20 to 0.75).
  • No clear stepwise dose-response relation was observed for any of the mortality outcomes, suggesting that the survival improvement is likely attributable to either consuming chilies rather than not consuming them.
  • The association of chili pepper intake with mortality risk was independent of the adherence to a Mediterranean diet.
  • Among studied biomarkers of CVD, only serum vitamin D marginally accounted for associations between chili pepper intake and mortality (explaining 6.1% of the association).


This observational study in a large cohort of Italian adults showed that regular consumption of chili peppers is associated with lower risk of total and CVD mortality. Large risk reductions were observed for ischemic heart disease and cerebrovascular death in those consuming chili peppers on a regular basis. The association of chili pepper consumption with lower mortality risk was independent of the adherence to a Mediterranean diet and most CVD biomarkers could not explain this association. Further studies are therefore needed to understand possible biological mechanisms that may be responsible for the observed effect of chili peppers on CV risk and mortality.


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9. Pisani P, Faggiano F, Krogh V, et al. Relative validity and reproducibility of a food frequency dietary questionnaire for use in the Italian EPIC centres. Int J Epidemiol 1997;26 Suppl 1:S152–60.

10. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 2003: 348:2599–608.

Find this article online at J Am Coll Cardiol.

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