Nonalcoholic fatty liver disease: daily aspirin use tied to lower risk for fibrosis progression

  • Simon TG & al.
  • Clin Gastroenterol Hepatol
  • 9 May 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • In patients with biopsy-proven non-alcoholic fatty liver disease (NAFLD), daily aspirin use was inversely associated with prevalent non-alcoholic steatohepatitis (NASH) and fibrosis.
  • In patients with early-stage fibrosis, daily aspirin use was associated with significantly lower risk for progressing to advanced fibrosis in a duration-dependent manner

Why this matters

  • Although preclinical data suggest that aspirin may protect against incidence and progression of NAFLD, clinical evidence focusing on aspirin use in NAFLD is limited.
  • Findings add to the growing literature supporting the potential hepatoprotective effects of aspirin in patients with NAFLD.

Study design

  • A prospective cohort study of 361 patients with biopsy-confirmed NAFLD who were revaluated 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).
  • Data on frequency and duration of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) use were collected.
  • Funding: National Institutes of Health and others.

Key results

  • Of 361 patients, 151 were daily aspirin users and 210 were non-regular users.
  • Compared with non-regular users, daily aspirin users were at lower risk for:
    • NASH (adjusted OR [aOR], 0.68; 95% CI, 0.37-0.89),
    • fibrosis (aOR, 0.54; 95% CI, 0.31-0.82) and
    • incident advanced fibrosis (Stage, 3-4; adjusted HR [aHR], 0.63; 95% CI, 0.43-0.85)
  • Compared with non-regular use, 2 to
  • Use of non-aspirin NSAIDs was not associated with reduced risk for incident advanced fibrosis (aHR, 0.93; 95% CI, 0.81-1.05).


  • Risk of residual confounding.
  • Possible recall bias and exposure misclassification because of self-reported data on aspirin use.