Daily aspirin use associated with reduced risk for fibrosis progression in patients with nonalcoholic fatty liver disease

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.

Authors

Simon TG1, Henson J2, Osganian S3, Masia R4, Chan AT5, Chung RT6, Corey KE7. Clin Gastroenterol Hepatol. 2019 May 8. pii: S1542-3565(19)30493-8. doi: 10.1016/j.cgh.2019.04.061. [Epub ahead of print]

Author Information

1.  Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital; Department of Medicine, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Clinical and Translational Epidemiology Unit (CTEU), Massachusetts General Hospital.

2.  Department of Medicine, Massachusetts General Hospital; Harvard Medical School, Boston, MA.

3.  Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital.

4.  Harvard Medical School, Boston, MA; Department of Pathology, Massachusetts General Hospital.

5.  Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital; Department of Medicine, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Clinical and Translational Epidemiology Unit (CTEU), Massachusetts General Hospital; Broad Institute, Boston MA; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston MA.

6.  Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital; Department of Medicine, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Broad Institute, Boston MA.

7.  Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital; Department of Medicine, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Clinical and Translational Epidemiology Unit (CTEU), Massachusetts General Hospital. Electronic address: kcorey@partners.org.

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