Daily aspirin use is associated with a substantially lower risk for incident hepatocellular carcinoma (HCC), and the benefit is greater when combined with a statin, according to study results published in the Journal of Clinical Gastroenterology.
The retrospective, single-center study included 521 patients with cirrhosis enrolled from July 1, 2012, to December 31, 2017. The main outcomes included developing HCC by the end of the follow-up on March 15, 2019 and the first occurrence of variceal hemorrhage.
Competing risk analysis was used to determine the association among risk factors including Child-Turcotte-Pugh (CTP) classification, age, sex, and time to HCC.
Study participants had a mean age of 58.7±10.7 years, 55% were men, and 90% were White. Among the cohort, 45 patients (8.6%) developed HCC, and 114 patients died by the end of the follow-up (93 died without HCC).
Univariable analysis showed that the patients who took aspirin alone (hazard ratio [HR], 0.35; CI, 0.12-0.97; P <.04) and patients who took a combination of aspirin and a statin (HR, 0.15; CI, 0.036-0.624; P <.009) had a statistically significant reduction in the risk for HCC compared with individuals who took neither (log-rank P =.001).
In the fully adjusted multivariable analysis, the association of aspirin use alone (HR, 0.266; CI, 0.094-0.755; P =.0129) and the combination of aspirin and statin use (HR, 0.113; CI, 0.026-0.483; P =.0033) remained statistically significant. Statin use alone vs neither aspirin nor statin use was associated with a reduced risk for HCC, but the decrease was not statistically significant (HR, 0.147; CI, 0.020-1.086; P =.0603).
Among patients without a history of variceal hemorrhage, no significant increase was found for the risk for esophageal variceal hemorrhage between participants who took aspirin vs those who took neither aspirin nor a statin (HR, 1.80; CI, 0.580-5.591; P =.3094).
Study limitations included the retrospective, single-center design. Researchers were also unable to assess the dose and duration of aspirin use on the main outcomes due to the patient sample size.
“…[O]ur analysis suggested the new finding that the combination of daily [aspirin] use and statin use together had a beneficial interaction in decreasing the risk [for] incident HCC,” the researchers wrote. “Finally, no excess [variceal hemorrhage] was observed in daily [aspirin] users compared with nonusers. Additional preclinical and clinical studies, namely randomized control trials, are needed to fully elucidate the benefit of daily [aspirin] use in the prevention of HCC in patients with cirrhosis.”
Singh J, Wozniak A, Cotler SJ, et al. Combined use of aspirin and statin is associated with a decreased incidence of hepatocellular carcinoma. J Clin Gastroenterol. 2022;56(4):369-373. doi:10.1097/MCG.0000000000001546