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Does an Aspirin a Day Take the MASLD Away?

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Abstract

Although aspirin is deeply rooted in the most ancient history of medicine, the mechanism of action of this drug was only identified a few decades ago. Aspirin has several indications ranging from its long-known analgesic and antipyretic properties to the more recently discovered antithrombotic, chemopreventive and anti-eclampsia actions. In addition, a recent line of research has identified aspirin as a drug with potential hepatologic indications. This article specifically focuses on the nonalcoholic fatty liver disease/nonalcoholic metabolic dysfunction fatty liver disease/metabolic dysfunction-associated steatotic liver disease (NAFLD/MAFLD/MASLD) field. To this end, the most recently published randomized controlled trial on aspirin for non-cirrhotic MASLD is summarized and discussed. Moreover, previous epidemiologic evidence supporting the notion that aspirin exerts antisteatotic and antifibrotic hepatic effects, which may result in the primary prevention of hepatocellular carcinoma, is also addressed. Next, the putative mechanisms involved are examined, with reference to the effects on adipose tissue and liver and sex differences in the action of aspirin. It is concluded that these novel findings on aspirin as a “hepatologic drug” deserve additional in-depth evaluation.

Plain Language Summary

Although aspirin is part of the history of medicine, its mechanism of action was only discovered a few decades ago. Aspirin can be used to treat pain, fever, inflammation and conditions where the blood tends to clot excessively (hypercoagulate) as well as for the prevention of certain types of cancer. Additionally, recent research has identified potential hepatologic indications and beneficial actions of aspirin among the so-called fatty liver disorders owing to conditions which disrupt the body’s regular metabolic functions and disorders (such as obesity and diabetes). This article discusses a recently published study while also addressing previous studies supporting the notion that aspirin might have pharmacologic action against fatty liver and its progression to scarring tissue (liver fibrosis and hepatic cirrhosis) and prevent the most common type of primary liver cancer. Aspirin not only acts on the blood cells that protect against hemorrhage (i.e., the platelets) but also targets other tissues such as adipose tissue and the liver. Importantly, biologic sex may affect the pharmacologic action of aspirin. Collectively, the discoveries summarized in our article justify additional investigations into aspirin as a “novel” drug in the hepatologic field.

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Data Availability

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

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Funding

No funding or sponsorship was received for this study or publication of this article.

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Authors and Affiliations

  1. Department of Internal Medicine, Ospedale Civile di Baggiovara (-2023), Azienda Ospedaliero-Universitaria di Modena, 41100, Modena, Italy

    Amedeo Lonardo

  2. Department of Hepatology, MAFLD Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China

    Ming-Hua Zheng

  3. Wenzhou Key Laboratory of Hepatology, Wenzhou, 325000, China

    Ming-Hua Zheng

  4. Institute of Hepatology, Wenzhou Medical University, Wenzhou, 325000, China

    Ming-Hua Zheng

  5. Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, 325000, China

    Ming-Hua Zheng

Authors
  1. Amedeo Lonardo
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  2. Ming-Hua Zheng
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Contributions

Study conception and design: Amadeo Lonardo; data collection: Amadeo Lonardo; analysis and interpretation of results: Amadeo Lonardo and Ming-Hua Zheng; draft manuscript preparation: Amadeo Lonardo and Ming-Hua Zheng. Both authors reviewed the final draft and approved the final version of the manuscript.

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Correspondence to Amedeo Lonardo.

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Conflict of Interest

Amedeo Lonardo is an Editorial Board member of Advances in Therapy. Amedeo Lonardo was not involved in the selection of peer reviewers for the manuscript or any of the subsequent editorial decisions. Ming-Hua Zheng has received honoraria for lectures from AstraZeneca, Hisky Medical Technologies and Novo Nordisk and consulting fees from Boehringer Ingelheim.

Ethical Approval

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

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Lonardo, A., Zheng, MH. Does an Aspirin a Day Take the MASLD Away?. Adv Ther 41, 2559–2575 (2024). https://doi.org/10.1007/s12325-024-02885-y

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  • DOI: https://doi.org/10.1007/s12325-024-02885-y

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