Combined Use of Aspirin and Statins Is Associated With Increased Risk of Metabolic Dysfunction–Associated Steatotic Liver Disease: A Study From National Health and Nutrition Examination Survey

TL;DR

Taking aspirin and statins together may increase the risk of liver disease linked to metabolic issues, according to a study of U.S. adults.

Contribution

This study identifies a novel association between combined aspirin and statin use and increased risk of MASLD and advanced liver fibrosis.

Findings

Combined aspirin and statin use is linked to a 49% higher risk of MASLD.

CAS therapy is associated with a 40% increased risk of advanced liver fibrosis.

Metabolic factors like obesity and diabetes influence the CAS-MASLD/fibrosis link.

Abstract

Aspirin and statins are often taken together in clinical practice. The impact of combined use of aspirin and statin (CAS) therapy on individuals with metabolic dysfunction–associated steatotic liver disease (MASLD) or advanced liver fibrosis (LF) remains uncertain. This study is aimed at exploring their associations in US adults.

This cross-sectional study used data from the 2011 to 2018 National Health and Nutrition Examination Survey, and 5889 participants were included. MASLD is based on the 2023 international expert consensus definition. Advanced LF is defined based on three commonly-used noninvasive fibrosis scores. Furthermore, prescriptions of aspirin and statins were categorized into untreated, single, and CAS to assess their potential associations with MASLD or advanced LF.

The CAS group consisted mostly of older (66 years), male (58.5%), non-Hispanic White (74.5%) individuals who were highly educated (58.0%), obese (45.7%), never smokers (43.8%), moderate drinkers (38.5%), and had hypertension (75.3%) and diabetes (39.9%). CAS was associated with a 49% higher risk of MASLD (OR: 1.49; 95% CI: 1.12–1.99) and a 40% higher risk of advanced LF (OR: 1.40; 95% CI: 1.02–1.92) after full adjustment. Notably, stratification and interaction analyses demonstrated that metabolic parameters such as overweight/obese, diabetes, and hypertriglyceridemia significantly influenced the association between CAS and MASLD or advanced LF.

In summary, the study indicates a positive correlation between CAS and MASLD or advanced LF. Using CAS should be cautious to avoid the increased risk of the above diseases.

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