Another View on Overviews

To the Editor.  —I enjoy your "Users' Guide to the Medical Literature" series and find these review articles useful for medical education. The article by Dr Oxman and colleagues¹ addressing how to use an overview was well organized, but the clinical example and overviews used were incomplete, and the results will mislead readers.The patient described in the clinical scenario has a cholesterol level of 7.9 mmol/L (305 mg/dL) with no other risk factors described. A lipoprotein breakdown or personal history of coronary heart disease is not provided. In the "Resolution of the Scenario" section the authors state (apparently derived from their overview research) that "the patient described in the scenario has a risk of dying of approximately 1.0% over the next decade."¹ According to many cohort studies and clinical trials, the patient has a much higher risk of death from coronary heart disease than stated, approximately 10%