Combined Use of Aspirin and Statin is Associated With a Decreased Incidence of Hepatocellular Carcinoma

Abstract

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer and cancer-related mortality worldwide. Studies have suggested that aspirin (ASA) and statins may be associated with a decrease in incident HCC. Goals: We aimed to evaluate the effect of ASA and statin use on the incidence of HCC in a prospective cohort of patients with liver cirrhosis and to identify if there was an increased risk of esophageal variceal hemorrhage (VH) in patients with ASA use. Study: We conducted a retrospective study of 521 patients with data collected from July 1, 2012 to December 31, 2017. We used competing risk analysis to assess the association between risk factors and HCC; and the association between ASA and VH. Results: ASA use alone was associated with a decreased incidence of HCC in the univariate and multivariate models; [hazard ratio (HR) confidence interval (CI): 0.348 (0.124-0.976); P=0.0448] and [HR (CI): 0.266 (0.094-0.755); P=0.0129, respectively]. The combination of ASA and statin use was associated with a decreased hazard of HCC [HR (CI): 0.15 (0.036-0.624); P=0.0090] and this remained statistically significant in the multivariable model [HR (CI): 0.113 (0.026-0.483); P=0.0033]. Among daily ASA users compared with non-users, there was not a significant increase in risk of VH. Conclusions: Daily ASA use was associated with a decrease risk of incident HCC. The combination of daily ASA use and statin use decreased the risk of incident HCC suggesting there is beneficial interaction. Finally, no excess VH was observed in daily ASA users compared with non-users.

Chemopreventive Effects of Concomitant or Individual Use of Statins, Aspirin, Metformin, and Angiotensin Drugs: A Study Using Claims Data of 23 Million Individuals

“…To date, combined use of two or more of statins, aspirin, metformin, and ACEIs/ARBs has not been thoroughly researched. Literature has suggested associations that support our findings in this study, including a reduced liver cancer risk in users of statins plus metformin [ 20 ] and in those of statins and aspirin [ 58 ]. There are, however, still earlier findings conflicting with ours, such as decreases in liver cancer risk among users of aspirin plus metformin [ 20 ] and in lung cancer risk among patients using statins, aspirin, plus metformin [ 18 ] identified in previous studies but not in this study.…”

The role of antiplatelet therapies on incidence and mortality of hepatocellular carcinoma

“…Data extracted from the selected articles are reported in detail in Tables 1 and 2. Among the 15 studies investigating the risk of HCC incidence, the majority ( n = 9, 60.0%) were carried out in Eastern countries, 5 (33.3%) in the United States and only 1 (6.7%) in Europe 15–29 . Nine studies were based on retrospective databases, while six studies were based on prospective data.…”

“…According to the data shown in Table 1, 15 studies reported the incidence of HCC in patients with or without APT 15–29 . A total of 2,685,009 patients were considered, with 25,188 (0.9%) incident HCC cases.…”

“…| RESULTS3.1 | Search results and study characteristicsThe PRISMA flow diagram depicts the article selection process (Figure1). Briefly, among the 493 articles screened, 156 articles were assessed for eligibility with 20 studies, 15 on HCC incidence and five on mortality outcome following treatment, which were finally included in the meta-analysis [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. …”

Emerging Evidence on Coronary Heart Disease Screening in Kidney and Liver Transplantation Candidates: A Scientific Statement From the American Heart Association

“…140 Risk of bleeding and benefit of aspirin for secondary prevention of CHD events should be considered on a case-by-case basis. In a prospective study of 521 patients with cirrhosis, the combination of aspirin and statin was associated a decreased risk of hepatocellular carcinoma and not associated with an increased risk of variceal hemorrhage, 156 suggesting that aspirin is safe and may have additional benefits in the context of liver disease.…”