In a study reported in The New England of Medicine, Tracey G. Simon, MD, MPH, and colleagues found that low-dose aspirin use was associated with a reduced risk of hepatocellular carcinoma and liver-related mortality among patients with chronic hepatitis B or C infection.
Tracey G. Simon, MD, MPH
Study Details
The study involved data from nationwide Swedish registries on patients diagnosed with chronic hepatitis B or hepatitis C from 2005 through 2015 (50,275 patients; 13,276 with hepatitis B and 36,999 with hepatitis C). Of these, 36,070 were aspirin nonusers; patients who were initiating low-dose aspirin (14,205 patients) were identified by their first filled prescriptions for 90 or more consecutive doses.
Patients excluded from the study included those who had received a previous diagnosis of human immunodeficiency virus or hepatocellular carcinoma or who filled prescriptions for aspirin or other antiplatelet agents before the end of the 180-day entry period.
Association With Hepatocellular Carcinoma and Liver-Related Mortality
The median follow-up was 7.9 years. Overall, there were 1,612 incident cases of hepatocellular carcinoma and 5,017 liver-related deaths.
The estimated cumulative incidence of hepatocellular carcinoma was 4.0% among aspirin users vs 8.3% among nonusers (difference = −4.3%, 95% confidence interval [CI] = −5.0 to −3.6%). Multivariate analysis yielded an adjusted hazard ratio [HR] of 0.69 (95% CI = 0.62–0.76).
The magnitude of risk reduction appeared to be dependent on the duration of aspirin use. Thus, on multivariate analysis, compared with short-term aspirin use (3 months to < 1 year), the adjusted hazard ratios were 0.90 (95% CI = 0.76–1.06) for 1 to less than 3 years of use, 0.66 (95% CI = 0.56–0.78) for 3 to less than 5 years of use, and 0.57 (95% CI = 0.42–0.70) for 5 or more years of use.
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Ten-year liver-related mortality was 11.0% among aspirin users and 17.9% among nonusers (difference = −6.9%, 95% CI = −8.1 to −5.7%). On multivariate analysis, the adjusted hazard ratio was 0.73 (95% CI = 0.67–0.81). The 10-year risk of gastrointestinal bleeding was 7.8% among aspirin users vs 6.9% among nonusers (difference = 0.9%, 95% CI = −0.6 to 2.4%).
The investigators concluded, “In a nationwide study of patients with chronic viral hepatitis in Sweden, use of low-dose aspirin was associated with a significantly lower risk of hepatocellular carcinoma and lower liver-related mortality than no use of aspirin, without a significantly higher risk of gastrointestinal bleeding.”
Disclosure: The study was funded by the National Institutes of Health and others. For full disclosures of the study authors, visit nejm.org.
