Taking daily aspirin may prevent progression of nonalcoholic fatty liver disease (NAFLD) to liver fibrosis and nonalcoholic steatopepatitis (NASH), according to a study published online May 8 in Clinical Gastroenterology and Hepatology.
"Our study was the first prospective study of its kind to demonstrate that aspirin is associated with less severe liver histology among patients with NAFLD, and that taking aspirin on a daily basis was associated with reduced risk of developing liver fibrosis over time," Tracey Simon, MD, from Massachusetts General Hospital and Harvard Medical School in Boston, told Medscape Medical News.
Until now, only two cross-sectional studies have evaluated the issue in humans, although results from rodent studies have suggested that aspirin may prevent progression to fibrosis in NAFLD.
While findings from the new study may not have direct clinical implications right now, Simon said they have "a lot of potential" to impact patient care in coming years.
Simon stressed the importance of continued effort to identify drug targets and underlying modifiable risk factors to prevent NAFLD progression, as the incidence and prevalence of NAFLD are accelerating dramatically in the United States.
Currently, about 50 million Americans have NAFLD, which is caused by fat accumulation in the organ. Up to 25% of individuals with NAFLD progress to liver fibrosis and are at risk for cirrhosis, liver cancer, and death, according to the authors.
While evidence no longer supports the use of daily aspirin for primary prevention of cardiovascular disease, these results raise the question whether providers should prescribe aspirin to prevent progression to NASH in patients with NAFLD.
Simon said that it's too early to answer that question.
"To my mind, the most important thing that our study could do is promote further research into this area to try and better characterize the role of aspirin for preventing fibrosis progression or preventing the development of NASH. With further research perhaps such recommendations could come in the future, but we're not there quite yet," she said.
The prospective study included 361 adults with biopsy-confirmed NAFLD who were enrolled in the Massachusetts General Hospital NAFLD Repository between 2006 and 2015. Among participants, 151 were already taking daily aspirin at the start of the study, mostly (54%) for primary cardiovascular disease prevention. Median duration of aspirin use at enrolment was 2.5 years.
Researchers confirmed NAFLD diagnoses through blinded medical record review. A blinded pathologist also assessed baseline liver biopsies.