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. 2019 Dec;17(13):2776-2784.e4.
doi: 10.1016/j.cgh.2019.04.061. Epub 2019 May 9.

Daily Aspirin Use Associated With Reduced Risk For Fibrosis Progression In Patients With Nonalcoholic Fatty Liver Disease

Tracey G Simon  1 , Jacqueline Henson  2 , Stephanie Osganian  3 , Ricard Masia  4 , Andrew T Chan  5 , Raymond T Chung  6 , Kathleen E Corey  7
Affiliations

Daily Aspirin Use Associated With Reduced Risk For Fibrosis Progression In Patients With Nonalcoholic Fatty Liver Disease

Tracey G Simon et al. Clin Gastroenterol Hepatol. 2019 Dec.

Abstract

Background & aims: There are few data from prospective studies on the effects of aspirin on fibrosis in patients with nonalcoholic fatty liver disease (NAFLD).

Methods: We performed a prospective cohort study of 361 adults with biopsy-confirmed NAFLD, from 2006 through 2015, examined every 3-12 months for incident advanced fibrosis defined using serial measurements of validated indices (the Fibrosis-4, NAFLD fibrosis score, and aspartate aminotransferase to platelet ratio indices). Histologic analyses of liver biopsies collected at baseline were performed by a blinded pathologist. Information collected at baseline and at each examination included frequency and duration of aspirin and nonsteroidal anti-inflammatory drug (NSAID) use. Using multivariable-adjusted logistic regression, we estimated the association of aspirin use with prevalent steatohepatitis (NASH) and fibrosis. Using multivariable-adjusted Cox proportional hazards modeling, we estimated the association between aspirin use and risk for fibrosis progression.

Results: At enrollment, 151 subjects used aspirin daily. Compared with non-regular use, daily aspirin use was associated with significantly lower odds of NASH (adjusted odds ratio, 0.68; 95% CI, 0.37-0.89) and fibrosis (adjusted odds ratio, 0.54; 95% CI, 0.31-0.82). Among individuals with baseline F0-F2 fibrosis (n = 317), 86 developed advanced fibrosis over 3692 person-years. Daily aspirin users had significantly lower risk for developing incident advanced fibrosis vs non-regular users (adjusted hazard ratio [aHR], 0.63; 95% CI, 0.43-0.85). This relationship appeared to be duration dependent (adjusted P trend=.026), with the greatest benefit found with at least 4 years or more of aspirin use (aHR, 0.50; 95% CI, 0.35-0.73). Conversely, use of nonaspirin NSAIDs was not associated with risk for advanced fibrosis (aHR, 0.93; 95% CI, 0.81-1.05).

Conclusions: In a prospective study of patients with biopsy-proven NAFLD, daily aspirin use was associated with less severe histologic features of NAFLD and NASH, and lower risk for progression to advanced fibrosis with time.

Keywords: Anti-fibrotic; Anti-inflammatory; Chronic Liver Disease; Prevention.

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Conflict of interest statement

Disclosures and conflicts of interest:

The authors have no disclosures and no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.. Cumulative incidence of advanced fibrosis1 with long-term daily aspirin use2, among patients with baseline early-stage NAFLD* (n=317)
Abbreviations: NAFLD, nonalcoholic fatty liver disease; No., number 1Incident advanced fibrosis was defined by the first recorded Fibrosis-4 (FIB-4) score > 2.67 or NAFLD Fibrosis Score (NFS) > 0.67, or aspartate aminotransferase-to-platelet ratio index (APRI) > 1.0 during study follow-up. Follow-up measurements of each index score was obtained at least annually in all included participants. 2Daily aspirin use was ascertained and verified by trained study staff at enrollment and at each clinical visit. Non-regular aspirin use was defined as less than daily use or non-use of aspirin. This variable was prospectively-updated during study follow-up and modeled as a time-varying exposure.. *Early-stage NAFLD defined as baseline fibrosis stage 0-2 on enrollment liver biopsy, confirmed by a blinded pathologist.
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References

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