Daily Aspirin Use Associated With Reduced Risk for Fibrosis Progression in Patients With Nonalcoholic Fatty Liver Disease

Simon et al1Simon T.G. et al.Clin Gastroenterol Hepatol. 2019; 17: 2776-2784.e4Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar recently published a report in Clinical Gastroenterology and Hepatology on their findings from a prospective cohort study of 361 adults with biopsy-confirmed nonalcholic fatty liver disease (NAFLD). Their study evaluated the relationship between daily aspirin use and risk for fibrosis progression defined by using serial measurements of validated indices (the Fibrosis-4, NAFLD fibrosis score, and aspartate aminotransferase-to-platelet ratio indices). They concluded that daily aspirin use was associated with less severe histologic features of NAFLD and nonalcoholic steatohepatitis and lower risk for progression to advanced fibrosis with time. After evaluating this article carefully, I think that some issues should be addressed. Aspirin is usually prescribed to patients at high cardiovascular risk, especially as a secondary prevention strategy. This patient profile often receives co-interventions with the intention of reducing risk to the lowest possible. Among them, I emphasize the modification of the lifestyle aiming at reducing weight. Because weight reduction is associated with improvement of liver histology in NAFLD,2Romero-Gómez M. et al.J Hepatol. 2017; 67: 829-846Abstract Full Text Full Text PDF PubMed Scopus (598) Google Scholar it would be important to know whether there was a significant weight loss before inclusion in the study. This undetected past weight loss is a very important potential source of bias. Just as the weight reduction resulting from lifestyle change is important in the baseline assessment, I believe that the longitudinal phase sensitivity analysis models should also include this variable. Thus, because of these arguments, I recommend caution in associating the daily use of aspirin with a lower probability of progression of fibrosis in NAFLD subjects until we have available results from well-designed randomized clinical trials. Daily Aspirin Use Associated With Reduced Risk For Fibrosis Progression In Patients With Nonalcoholic Fatty Liver DiseaseClinical Gastroenterology and HepatologyVol. 17Issue 13PreviewThere are few data from prospective studies on the effects of aspirin on fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). Full-Text PDF ReplyClinical Gastroenterology and HepatologyVol. 18Issue 2PreviewWe thank Simon et al1 for their interest in our prospective study of aspirin use in patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD). The authors highlight that in addition to aspirin, weight loss is a central component of cardiovascular risk reduction, and this in turn can directly influence NAFLD histology. To that end, we would like to emphasize 3 important aspects of our study population and design. First, <10% of subjects in our cohort had pre-enrollment weight loss exceeding 10% in the 6 months preceding index liver biopsy. Full-Text PDF