Lee Chern-Horng, Huang Yu-Han, Hsu Tzu-Ju, Yen Tzung-Hai, Hsieh Sen-Yung
Department of Geriatric Medicine and General Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, 333, Taiwan.
Department of Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan, College of Medicine, China Medical University, Taichung, Taiwan.
Int J Gen Med. 2024 Dec 27;17:6495-6511. doi: 10.2147/IJGM.S481724. eCollection 2024.
Metabolic dysfunction-associated fatty liver disease (MAFLD) and metabolic dysfunction-associated steatohepatitis (MASH) pose significant risks for liver cirrhosis and hepatocellular carcinoma (HCC). Daily aspirin and statins could reduce HCC in patients with MAFLD/MASH. We aimed to clarify whether combined aspirin and statins exert a synergistic effect on prevention of cirrhosis and HCC in patients with MAFLD/MASH.
Patients and their clinical data were collected from the National Health Insurance Research Database (NHIRD), encompassing about 20 million population. A total of 735,574 MAFLD/MASH patients between January 1, 2009, and December 31, 2020 were identified. After applying exclusion criteria, 662,004 cases were enrolled, with a follow-up period of 3 years. Propensity score matching was employed for comparative analysis.
Our findings indicate that combined statin and aspirin use significantly reduced the incidence of liver cirrhosis (p < 0.001) compared to statin or aspirin alone, or non-use of both drugs. However, the combined therapy did not confer additional benefits in reducing mortality rates and HCC. Furthermore, statin monotherapy exhibited a more pronounced effect in reducing mortality and HCC compared to aspirin alone or combined therapy.
Our study underscores that statin monotherapy was not inferior to aspirin or aspirin-statin combined therapies in terms of chemoprevention of cirrhosis, HCC, and overall mortality in MAFLD/MASH patients.
代谢功能障碍相关脂肪性肝病（MAFLD）和代谢功能障碍相关脂肪性肝炎（MASH）会给肝硬化和肝细胞癌（HCC）带来重大风险。每日服用阿司匹林和他汀类药物可降低MAFLD/MASH患者患HCC的风险。我们旨在阐明阿司匹林和他汀类药物联合使用对预防MAFLD/MASH患者肝硬化和HCC是否具有协同作用。
从涵盖约2000万人口的国民健康保险研究数据库（NHIRD）中收集患者及其临床数据。共识别出2009年1月1日至2020年12月31日期间的735574例MAFLD/MASH患者。应用排除标准后，纳入662004例病例，随访期为3年。采用倾向评分匹配法进行比较分析。
我们的研究结果表明，与单独使用他汀类药物或阿司匹林，或两种药物都不使用相比，联合使用他汀类药物和阿司匹林可显著降低肝硬化的发生率（p < 0.001）。然而，联合治疗在降低死亡率和HCC发生率方面并未带来额外益处。此外，与单独使用阿司匹林或联合治疗相比，他汀类药物单药治疗在降低死亡率和HCC发生率方面表现出更显著的效果。
我们的研究强调，在预防MAFLD/MASH患者肝硬化、HCC和总体死亡率方面，他汀类药物单药治疗并不逊色于阿司匹林或阿司匹林 - 他汀类药物联合治疗。
