Sidney et al. [1] report a large database analysis, which purports to show an increased risk of venous and arterial thromboembolism (VTE and ATE) in users of the 30 meg ethinylestradiol (EE)/3 mg drospirenone (DRSP) preparation, compared to several older combined pills (COCs). It is a recurring problem that databases do not contain important information necessary for such analyses [2]. In this case, there was no information at all regarding body mass index (BMI), smoking or family history. The European Active Surveillance (EURAS) study showed that obesity was more common (1.6-fold higher) among users of DRSP-containing COCs compared to users of levonorgestrel (LNG) and other progestogen containing COCs. The EURAS study showed that adjustment for age, BMI, duration of current use, family history of VTE and the interaction between age and BMI reduced the VTE relative risk by 27%, as compared with an analysis that adjusted only for age.
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