Atif Zaman, MD, MPH reviewing
Daily aspirin use reduced risk for fibrosis progression.
One of the key predictors of increased liver-related morbidity and mortality in patients with nonalcoholic fatty liver disease (NAFLD) is the development and progression of liver fibrosis. Recent studies have shown that aspirin may have antifibrotic effects in NAFLD. In murine models, aspirin limits hepatic stellate cell activation by inhibiting the cyclooxygenase-2 (COX-2) enzyme, and antagonism of COX-2 seems to improve nonalcoholic steatohepatitis (NASH)–related fibrosis. In humans, much of the literature has been limited to cross-sectional studies.
Now, investigators have conducted a prospective cohort study involving 361 adults with biopsy-proven NAFLD, 151 of whom were daily aspirin users. Participants underwent evaluation every 3 to 12 months for development of fibrosis, using serum fibrosis markers.
At baseline, daily aspirin users versus nonregular users had lower odds of having NASH (adjusted odds ratio, 0.68) or fibrosis (aOR, 0.54). During a median of 3692 person-years, daily aspirin users had lower rates of advanced fibrosis (adjusted hazard ratio, 0.63), with the greatest benefit occurring in those taking daily aspirin for ≥4 years (Ptrend=0.026). Nonaspirin NSAID use did not affect fibrosis rates.
COMMENT
This is the first prospective study to evaluate the potential benefits of daily aspirin use in NAFLD patients. Although this is not a randomized study, the duration-dependent relationship of aspirin to NAFLD-related fibrosis, coupled with the biologic plausibility of the antifibrotic effects of aspirin in NAFLD patients, makes the results compelling. Given the growing body of literature around the association of NAFLD and cardiovascular disease, the use of aspirin in NAFLD patients seems appropriate to consider in clinical practice.
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