Aspirin and Statin Combination Therapy Linked to Lower Risk for HCC

Investigators sought to determine the effect of combined therapy with aspirin and statins on the incidence of hepatocellular carcinoma.

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.”

Reference

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