Could Aspirin Help Protect Against Liver Fibrosis?
A new study finds that aspirin may be useful in protecting against liver fibrosis, particularly for individuals at risk for chronic liver disease.
In a population-based cross-sectional study of more than 14,000 adults, a team of researchers from Beth Israel Deaconess Medical Center drew on the National Health and Nutrition Examination Survey (NHANES) III to examine the connection between aspirin, ibuprofen, and liver fibrosis.
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Fibrosis was measured with 4 validated noninvasive indices: Fibrosis-4, the nonalcoholic fatty liver disease fibrosis score, the aspartate aminotransferase/platelet ratio index, and the Forns Index. The researchers did additional analyses in patients with viral hepatitis, those with fatty liver disease as well as heavy drinkers.
On the aforementioned 4 measures, the investigators found the use of aspirin was consistently associated with lower stages of fibrosis, while there was essentially no connection between the use of ibuprofen and liver fibrosis. In addition, an analysis of patients with and without chronic liver disease—a hepatitis B or C infection, those who consumed more than 5 alcoholic drinks a day, or suspected non-alcoholic steatohepatitis—aspirin, but not ibuprofen, was consistently linked to lower stages of fibrosis. Patients with liver disease, or at risk for liver disease saw the negative coefficient for the interaction between aspirin use and liver fibrosis increase fivefold, which the authors say suggests the protective effect of aspirin is much greater in patients with chronic liver disease.
“To date, interventions against chronic liver disease have been limited to addressing its underlying cause, whereas direct anti-fibrotic treatment is not available,” says Z. Gordon Jiang, MD, PhD, a clinical fellow in the division of gastroenterology and hepatology at Beth Israel Deaconess Medical Center, and a co-author of the study.
While noting that its premature to make recommendations of aspirin in chronic liver diseases based on a single observational study, “a significant number of patients with chronic liver diseases already have the indication for daily low dose aspirin as a primary prevention against cardiovascular and cerebrovascular diseases,” says Jiang.
“This is especially true for patients with nonalcoholic fatty liver diseases,” he says. “In the primary care setting, I hope our study provides another opportunity to think about these recommendations, and [is an] additional incentive for patients to take on this simple intervention in the right clinical setting.”
Aspirin is sometimes discontinued among patients with fibrosis in the absence of cirrhosis due to the fear of gastrointestinal bleeding, says Ziang, adding that this study may provide a reason for pause to reconsider the pros and cons of this decision that currently cannot be guided by evidence.
“This is an evolving topic that demands additional evidence in both basic science and clinical investigation,” he says. “I am hopeful that more studies, including randomized controlled trials, will be available in the near future to guide our practice.”
The findings were originally presented at The Liver Meeting 2014, the 65th annual meeting of the American Association for the Study of Liver Diseases, held Nov. 7 – 11 in Boston, Mass.
—Mark McGraw