Daily aspirin use was associated with less severe histologic features of nonalcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH), and with lower risk for progression to advanced fibrosis with time, according to a study recently published in Clinical Gastroenterology and Hepatology.
The investigators conducted a prospective cohort study of adults with biopsy-confirmed NAFLD between 2006 and 2015. Patients were regularly examined for incident advanced fibrosis. Liver biopsies collected at baseline were used for histologic analysis. At each examination, data collection included the frequency and duration of aspirin and nonsteroidal anti-inflammatory drug (NSAID) use to test for their potential associations with NASH and fibrosis.
Of 361 enrolled patients, 151 used aspirin daily (41.8%). Compared with patients with nonregular use, patients who used aspirin daily had significantly lower odds of NASH (adjusted odds ratio [OR], 0.68; 95% CI, 0.37-0.89) and fibrosis (adjusted OR, 0.54; 95% CI, 0.31-0.82).
Over the course of 3692 person-years, 86 (27.1%) of 317 patients who had F0-F2 fibrosis at baseline developed advanced fibrosis. Patients who used aspirin daily had significantly lower risk for advanced fibrosis compared with those who did not use aspirin daily (adjusted hazard ratio [aHR], 0.63; 95% CI: 0.43-0.85).
Longer duration of aspirin use was associated with progressively reduced risk for advanced fibrosis (Ptrend =.026). In contrast, the use of other NSAIDs was not associated with risk for advanced fibrosis (aHR, 0.93; 95% CI, 0.81-1.05).
Limitations of this observational study included the possibility of residual confounding, potential recall bias and exposure misclassification from self-reported aspirin use data, potential confounding by indication from self-selected aspirin use, the possibility of immortal time bias, and a mostly white study population.
The authors concluded that their findings provide support for the potential hepatoprotective effects of aspirin in patients with NAFLD. Studies to uncover the mechanisms by which aspirin might prevent fibrogenesis may potentially help develop urgently needed antifibrotic therapies for NAFLD.
Simon TG, Henson J, Osganian S, et al. Daily aspirin use associated with reduced risk for fibrosis progression in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2019;17(13):2776-2784.