The chemoprotective effect of anti-platelet agents on cancer incidence in people with non-alcoholic fatty liver disease (NAFLD): a retrospective cohort study
Abstract Background Non-alcoholic fatty liver disease (NAFLD) is associated with an increased incidence of hepatic and extrahepatic cancers, in particular those linked to obesity. In people with chronic liver disease, aspirin may confer protection against hepatocellular carcinoma (HCC). We explore t...
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2024-12-01
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| author | Matthew Anson Jun Shang Poon Alex E. Henney David Riley Gema H. Ibarbaru Cyril Sieberhagen Daniel J. Cuthbertson Uazman Alam Theresa Hydes |
| author_facet | Matthew Anson Jun Shang Poon Alex E. Henney David Riley Gema H. Ibarbaru Cyril Sieberhagen Daniel J. Cuthbertson Uazman Alam Theresa Hydes |
| author_sort | Matthew Anson |
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| description | Abstract Background Non-alcoholic fatty liver disease (NAFLD) is associated with an increased incidence of hepatic and extrahepatic cancers, in particular those linked to obesity. In people with chronic liver disease, aspirin may confer protection against hepatocellular carcinoma (HCC). We explore the potential chemoprotective effect of aspirin/other anti-platelet agents on obesity-related cancers, including HCC in people with NAFLD. Methods We performed a retrospective cohort study of anonymised electronic medical records using the TriNetX network (Cambridge, MA, USA), a global federated database. We identified adults aged 18 or over with a diagnosis of NAFLD, prior to commencing antiplatelet agents. Two groups were created: antiplatelet (1) versus no antiplatelet use (2). We propensity score matched for nine variables. Antiplatelet use was defined as aspirin, ticagrelor, cangrelor, clopidogrel or prasugrel use for at least 1 year. The outcomes of interest were incidence of HCC and other obesity-related cancers. Follow-up was for 5 years. We performed subgroup analyses on aspirin users only and stratified findings for sex and age. Sensitivity analysis was conducted on individuals with 3- and 5-year aspirin exposure. Results Post matching, there were 42,192 people per group. Antiplatelet use in people with NAFLD was associated with statistically significant reduction in all obesity-related cancers (HR 0.71, 95% CI 0.65–0.78, p < 0.001) and individually for HCC (HR 0.52, 95% CI 0.40–0.68, p < 0.001), breast carcinoma (HR 0.78, 95% CI 0.66–0.92, p = 0.003), pancreatic carcinoma (HR 0.61, 95% CI 0.47–0.78, p < 0.001) and colorectal carcinoma (HR 0.68, 95% CI 0.56–0.84, p < 0.001). For women, there was a significant reduction in risk of ovarian carcinoma (HR 0.75, 95% CI 0.57–0.98, p = 0.034). Aspirin monotherapy was similarly associated with reduced incidence of HCC (HR 0.46, 95% CI 0.32–0.64, p < 0.001) and all obesity-related cancers (HR 0.71, 95% CI, 0.56–0.90, p = 0.004), with benefits observed in males (HR 0.71, 95% CI 0.56–0.90, p = 0.004), females (HR 0.77, 95% CI 0.67–0.88, p < 0.001) and in older (HR 0.72, 95% CI 0.63–0.82, p < 0.001) but not younger people (HR 0.78, 95% CI 0.60–1.03, p = 0.589). Conclusions Aspirin/antiplatelet agents may have a role in primary cancer prevention in people living with NAFLD. |
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| spelling | doaj-art-a1f3bd897ec04808ba8c9ecdca158adf2025-08-20T01:56:01ZengBMCBMC Medicine1741-70152024-12-0122111610.1186/s12916-024-03802-4The chemoprotective effect of anti-platelet agents on cancer incidence in people with non-alcoholic fatty liver disease (NAFLD): a retrospective cohort studyMatthew Anson0Jun Shang Poon1Alex E. Henney2David Riley3Gema H. Ibarbaru4Cyril Sieberhagen5Daniel J. Cuthbertson6Uazman Alam7Theresa Hydes8Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of LiverpoolUniversity Hospital Aintree, Liverpool University Hospitals NHS Foundation TrustDepartment of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of LiverpoolDepartment of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of LiverpoolTriNetX LLCUniversity Hospital Aintree, Liverpool University Hospitals NHS Foundation TrustDepartment of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of LiverpoolDepartment of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of LiverpoolDepartment of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of LiverpoolAbstract Background Non-alcoholic fatty liver disease (NAFLD) is associated with an increased incidence of hepatic and extrahepatic cancers, in particular those linked to obesity. In people with chronic liver disease, aspirin may confer protection against hepatocellular carcinoma (HCC). We explore the potential chemoprotective effect of aspirin/other anti-platelet agents on obesity-related cancers, including HCC in people with NAFLD. Methods We performed a retrospective cohort study of anonymised electronic medical records using the TriNetX network (Cambridge, MA, USA), a global federated database. We identified adults aged 18 or over with a diagnosis of NAFLD, prior to commencing antiplatelet agents. Two groups were created: antiplatelet (1) versus no antiplatelet use (2). We propensity score matched for nine variables. Antiplatelet use was defined as aspirin, ticagrelor, cangrelor, clopidogrel or prasugrel use for at least 1 year. The outcomes of interest were incidence of HCC and other obesity-related cancers. Follow-up was for 5 years. We performed subgroup analyses on aspirin users only and stratified findings for sex and age. Sensitivity analysis was conducted on individuals with 3- and 5-year aspirin exposure. Results Post matching, there were 42,192 people per group. Antiplatelet use in people with NAFLD was associated with statistically significant reduction in all obesity-related cancers (HR 0.71, 95% CI 0.65–0.78, p < 0.001) and individually for HCC (HR 0.52, 95% CI 0.40–0.68, p < 0.001), breast carcinoma (HR 0.78, 95% CI 0.66–0.92, p = 0.003), pancreatic carcinoma (HR 0.61, 95% CI 0.47–0.78, p < 0.001) and colorectal carcinoma (HR 0.68, 95% CI 0.56–0.84, p < 0.001). For women, there was a significant reduction in risk of ovarian carcinoma (HR 0.75, 95% CI 0.57–0.98, p = 0.034). Aspirin monotherapy was similarly associated with reduced incidence of HCC (HR 0.46, 95% CI 0.32–0.64, p < 0.001) and all obesity-related cancers (HR 0.71, 95% CI, 0.56–0.90, p = 0.004), with benefits observed in males (HR 0.71, 95% CI 0.56–0.90, p = 0.004), females (HR 0.77, 95% CI 0.67–0.88, p < 0.001) and in older (HR 0.72, 95% CI 0.63–0.82, p < 0.001) but not younger people (HR 0.78, 95% CI 0.60–1.03, p = 0.589). Conclusions Aspirin/antiplatelet agents may have a role in primary cancer prevention in people living with NAFLD.https://doi.org/10.1186/s12916-024-03802-4Hepatocellular carcinomaNon-alcoholic fatty liver diseaseAspirinAnti-plateletsObesity |
| spellingShingle | Matthew Anson Jun Shang Poon Alex E. Henney David Riley Gema H. Ibarbaru Cyril Sieberhagen Daniel J. Cuthbertson Uazman Alam Theresa Hydes The chemoprotective effect of anti-platelet agents on cancer incidence in people with non-alcoholic fatty liver disease (NAFLD): a retrospective cohort study BMC Medicine Hepatocellular carcinoma Non-alcoholic fatty liver disease Aspirin Anti-platelets Obesity |
| title | The chemoprotective effect of anti-platelet agents on cancer incidence in people with non-alcoholic fatty liver disease (NAFLD): a retrospective cohort study |
| title_full | The chemoprotective effect of anti-platelet agents on cancer incidence in people with non-alcoholic fatty liver disease (NAFLD): a retrospective cohort study |
| title_fullStr | The chemoprotective effect of anti-platelet agents on cancer incidence in people with non-alcoholic fatty liver disease (NAFLD): a retrospective cohort study |
| title_full_unstemmed | The chemoprotective effect of anti-platelet agents on cancer incidence in people with non-alcoholic fatty liver disease (NAFLD): a retrospective cohort study |
| title_short | The chemoprotective effect of anti-platelet agents on cancer incidence in people with non-alcoholic fatty liver disease (NAFLD): a retrospective cohort study |
| title_sort | chemoprotective effect of anti platelet agents on cancer incidence in people with non alcoholic fatty liver disease nafld a retrospective cohort study |
| topic | Hepatocellular carcinoma Non-alcoholic fatty liver disease Aspirin Anti-platelets Obesity |
| url | https://doi.org/10.1186/s12916-024-03802-4 |
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