title: Aspirin use is associated with lower indices of liver fibrosis among adults in the United States.
abstract: BACKGROUND
  Recent animal studies have shown that platelets directly activate hepatic stellate cells to promote liver fibrosis, whereas anti-platelet agents decrease liver fibrosis. It is unknown whether platelet inhibition by aspirin prevents liver fibrosis in humans.
  
  
  OBJECTIVE
  To examine the association between aspirin use and liver fibrosis among adults with suspected chronic liver disease.
  
  
  METHODS
  We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey III. We identified 1856 individuals with suspected chronic liver disease (CLD). The degree of liver fibrosis was determined using four validated fibrosis indices and a composite index.
  
  
  RESULTS
  The use of aspirin was associated with a significantly lower composite liver fibrosis index calculated from FIB4, APRI, Forns and NFS [0.24 standard deviation (s.d.) units lower; 95% CI -0.42 to -0.06, P = 0.009]. The association of aspirin with lower fibrosis scores was significantly larger among those with suspected CLD compared to those without (-0.23 vs. -0.03 s.d. units; P interaction = 0.05). The negative association between aspirin use and lower fibrosis index was consistent across all four fibrosis indices (P = 0.002-0.08) in individuals with chronic viral hepatitis, suspected alcoholic liver disease and NASH. In comparison, no negative associations with liver fibrosis were seen with ibuprofen in parallel analyses.
  
  
  CONCLUSIONS
  The use of aspirin was associated with significantly lower indices of liver fibrosis among US adults with suspected chronic liver diseases. Aspirin and other anti-platelet drugs warrant further investigation for the prevention and treatment of liver fibrosis.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Z Gordon
authors.initials: ZG
authors.lastname: Jiang
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Feldbrügge
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: E B
authors.initials: EB
authors.lastname: Tapper
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Popov
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: T
authors.initials: T
authors.lastname: Ghaziani
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: N
authors.initials: N
authors.lastname: Afdhal
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Robson
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Mukamal
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D005260:Female; D006521:Hepatitis, Chronic / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000517:prevention & control*; D008108:Liver Diseases, Alcoholic / Q000503:physiopathology; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000503:physiopathology; D009749:Nutrition Surveys; D014481:United States
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin