Association of aspirin use alone with mortality and liver-related events in MASLD: a multi-institutional three-year study.

BACKGROUND: The global prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as NAFLD, is increasing. While daily aspirin use has been associated with reduced hepatocellular carcinoma (HCC) risk in NAFLD, its impact on mortality and liver-related outcomes in MASLD remains unclear. METHODS: This retrospective, multi-institutional cohort study included 48,722 MASLD patients from 2008 to 2020, divided into aspirin users and non-users. Exclusion criteria included significant cardiac disease unrelated to aspirin, alcoholic liver disease, incomplete follow-up, and concomitant use of other antiplatelet therapies. Propensity score matching (PSM) was performed to balance baseline characteristics, including demographics, cirrhosis status, ALT levels, cardiovascular conditions, and concurrent medications. RESULTS: After PSM, 2003 patients were included in each cohort. Aspirin users had a mean duration of use of 4.59 ± 3.97 years, with 97% on a daily dose of 75-100 mg. Over three years, aspirin use was not significantly associated with reductions in overall mortality, liver-related events, liver-related mortality, or HCC incidence compared to non-users. However, a trend toward lower liver-related mortality and HCC incidence was observed without an increased risk of major bleeding. CONCLUSION: In this large cohort, daily aspirin use alone did not significantly reduce mortality or liver-related events in MASLD patients over three years. The observed trends may suggest potential long-term benefits, warranting further investigation into extended aspirin duration and combination strategies for MASLD management.