Nov. 29, 2012— -- Aspirin and other nonsteroidal anti-inflammatory drugs or NSAIDS may help prevent serious liver disease including cancer, new study found.
Aspirin users were 41 percent less likely to develop liver cancer and 45 percent less likely to die from chronic liver disease than non-users, according to study author Vikrant Sahasrabuddhe of the National Cancer Institute in Rockville, Md., and colleagues.
Other NSAIDs were also linked to a lower risk of death from chronic liver disease, but not with less liver cancer, according to the study of more than 300,000 middle-age and older adults.
"These associations are prominent with the use of aspirin, and if confirmed, might open new vistas for chemoprevention of hepatocellular carcinoma and chronic liver disease," the study authors wrote in the Dec. 5 issue of the Journal of the National Cancer Institute.
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The findings were not unexpected based on prior results in colorectal and other cancer types, Dr. Boris Pasche, an oncologist at the University of Alabama at Birmingham, said in an interview with MedPage Today.
"We are seeing a growing body of evidence suggesting that taking aspirin long-term prevents the development of several types of cancer" in populations taking the NSAID for cardiovascular event prevention, he said.
However, aside from being a possible additional benefit when indicated for cardioprotection, aspirin might not be either necessary or that useful for protecting the liver, according to other experts.
For one thing, there are already good strategies that don't raise bleeding risk the way NSAIDs do, Isra Levy and Dr. Carolyn Pim, both of the University of Ottawa and Ottawa Public Health in Ontario, noted in an accompanying editorial.
"In practice," they wrote, "we know and understand the causes of most cases of chronic liver disease and primary liver cancer: viral infections, especially hepatitis B virus (HBV) and hepatitis C virus (HCV), and alcohol. And we already have cheap, readily available interventions to prevent a substantial majority of such diseases."
Furthermore, the risk of developing hepatocellular carcinoma is low enough in the general population that chemoprevention wouldn't make sense when weighed against the bleeding risk, said Dr. Mary Ann Huang, a hepatologist at Henry Ford Hospital in Detroit.
The higher-risk population for whom preventive strategies are needed -- those with cirrhosis -- likely wouldn't be good candidates either because they are also at higher risk of bleeding, Huang told MedPage Today in an interview.
Still the NIH-AARP study results may be good enough to warrant a prospective trial to see whether the benefit would outweigh the risk in that population, Pasche suggested.
The joint Diet and Health study included 300,504 adults ages 50 to 71 years at enrollment who reported their NSAID use on a baseline questionnaire.
The cohort was pulled from six states (California, Florida, Louisiana, New Jersey, North Carolina, and Pennsylvania) and two metropolitan areas (Atlanta and Detroit). Among the respondents, 73 percent reported aspirin use and 56 percent used other NSAIDs.
Aspirin's effects were independent of frequency of use.
All the results were adjusted for age, sex, race or ethnicity, body mass index, cigarette smoking, alcohol consumption, and diabetes.
The researchers suggested that the apparent advantage of NSAID use in the cohort may have been due to anti-inflammatory or other mechanisms.
They acknowledged, though, that the lack of dose response and finding of only monthly links to non-aspirin NSAID use "suggests that the findings should be interpreted with some caution, because they may also reflect an unmeasured confounder."