Arnaud Chiolero

McGill University, Montréal, Quebec, Canada

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Publications (126)663.9 Total impact

  • Jean-Luc Bulliard · Arnaud Chiolero ·
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    ABSTRACT: Overdiagnosis is the diagnosis of an abnormality that bears no substantial health hazard and no benefit for patients to be aware of. Resulting mainly from the use of increasingly sensitive screening and diagnostic tests, as well as broadened definitions of conditions requiring an intervention, overdiagnosis is a growing but still largely misunderstood public health issue. Fear of missing a diagnosis or of litigation, financial incentives or patient’s need of reassurance are further causes of overdiagnosis. The main consequence of overdiagnosis is overtreatment. Treating an overdiagnosed condition bears no benefit but can cause harms and generates costs. Overtreatment also diverts health professionals from caring for those most severely ill. Recognition of overdiagnosis due to screening is challenging since it is rarely identifiable at the individual level and difficult to quantify precisely at the population level. Overdiagnosis exists even for screening of proven efficacy and efficiency. Measures to reduce overdiagnosis due to screening include heightened sensitization of health professionals and patients, active surveillance and deferred treatment until early signs of disease progression and prognosis estimation through biomarkers (including molecular) profiling. Targeted screening and balanced information on its risk and benefits would also help limit overdiagnosis. Research is needed to assess the public health burden and implications of overdiagnosis due to screening activity.
    12/2015; 36(1). DOI:10.1186/s40985-015-0012-1
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    Pascal Bovet · Arnaud Chiolero · Fred Paccaud · Nick Banatvala ·

    12/2015; 36(1). DOI:10.1186/s40985-015-0013-0
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    ABSTRACT: Cardiovascular diseases (CVD) are the leading cause of death worldwide. Individual detection and intervention on CVD risk factors and behaviors throughout childhood and adolescence has been advocated as a strategy to reduce CVD risk in adulthood. The U.S. National Heart, Lung, and Blood Institute (NHLBI) has recently recommended universal screening of several risk factors in children and adolescents, at odds with several recommendations of the U.S. Services Task Force and of the U.K. National Screening committee. In the current review, we discuss the goals of screening for CVD risk factors (elevated blood pressure, abnormal blood lipids, diabetes) and behaviors (smoking) in children and appraise critically various screening recommendations. Our review suggests that there is no compelling evidence to recommend universal screening for elevated blood pressure, abnormal blood lipids, abnormal blood glucose, or smoking in children and adolescents. Targeted screening of these risk factors could be useful but specific screening strategies have to be evaluated. Research is needed to identify target populations, screening frequency, intervention, and follow-up. Meanwhile, efforts should rather focus on the primordial prevention of CVD risk factors and at maintaining a lifelong ideal cardiovascular health through environmental, policy, and educational approaches.
    11/2015; 36(1):9. DOI:10.1186/s40985-015-0011-2
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    A Chiolero · M Burnier · V Santschi ·
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    ABSTRACT: Journal of Human Hypertension is exclusively concerned with all clinical aspects of human hypertension. The journal publishes fully refereed original research papers from around the world.
    Journal of human hypertension 08/2015; DOI:10.1038/jhh.2015.89 · 2.70 Impact Factor
  • T. Lohse · S. Rohrmann · M. Bopp · A. Chiolero · D. Faeh ·

    Atherosclerosis 07/2015; 241(1):e138. DOI:10.1016/j.atherosclerosis.2015.04.478 · 3.99 Impact Factor
  • Arnaud Chiolero · Gilles Paradis · Fred Paccaud ·

    International Journal of Epidemiology 06/2015; DOI:10.1093/ije/dyv102 · 9.18 Impact Factor
  • C Bloetzer · P Bovet · A Chiolero ·
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    ABSTRACT: As universal screening of hypertension performs poorly in childhood, targeted screening to children at higher risk of hypertension has been proposed. Our goal was to assess the performance of combined parental history of hypertension and overweight/obesity to identify children with hypertension. We estimated the sensitivity, specificity, negative and positive predictive values of overweight/obesity and parental history of hypertension for the identification of hypertension in children. We analyzed data from a school-based cross-sectional study including 5207 children aged 10 to 14 years from all public 6th grade classes in the canton of Vaud, Switzerland. Blood pressure was measured with a clinically validated oscillometric automated device over up to three visits separated by one week. Children had hypertension if they had sustained elevated blood pressure over the three visits. Parents were interviewed about their history of hypertension. The prevalence of hypertension was 2.2%. 14% of children were overweight or obese and 20% had a positive history of hypertension in either or both parents. 30% of children had either or both conditions. After accounting for several potential confounding factors, parental history of hypertension (odds ratio (OR): 2.6; 95% confidence interval (CI): 1.8-4.0), overweight excluding obesity (OR: 2.5; 95% CI: 1.5-4.2) and obesity (OR: 10.1; 95% CI: 6.0-17.0) were associated with hypertension in children. Considered in isolation, the sensitivity and positive predictive values of parental history of hypertension (respectively 41% and 5%) or overweight/obesity (respectively 43% and 7%) were relatively low. Nevertheless, considered together, the sensitivity of targeted screening in children with either overweight/obesity or paternal history of hypertension was higher (65%) but the positive predictive value remained low (5%). The negative predictive value was systematically high. Restricting screening of hypertension to children with either overweight/obesity or with hypertensive parents would substantially limit the proportion of children to screen (30%) and allow the identification of a relatively large proportion (65%) of hypertensive cases. That could be a valuable alternative to universal screening.
    Journal of Hypertension 06/2015; 33 Suppl 1 - ESH 2015 Abstract Book:e34. DOI:10.1097/01.hjh.0000467438.15493.44 · 4.72 Impact Factor
  • Arnaud Chiolero · Pascal Bovet · Gilles Paradis ·

    Journal of Hypertension 04/2015; 33(7). DOI:10.1097/HJH.0000000000000579 · 4.72 Impact Factor
  • Clemens Bloetzer · Fred Paccaud · Michel Burnier · Pascal Bovet · Arnaud Chiolero ·
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    ABSTRACT: Several guidelines recommend universal screening for hypertension in childhood and adolescence. Targeted screening to children with parental history of hypertension could be a more efficient strategy than universal screening. Therefore, we assessed the association between parental history of hypertension and hypertension in children, and estimated the sensitivity, specificity, negative, and positive predictive values of parental history of hypertension for hypertension in children. The present study was a school-based cross-sectional study including 5207 children aged 10-14 years from all public 6th grade classes in the Canton of Vaud, Switzerland. Children had hypertension if they had sustained elevated blood pressure over three separate visits. In children, the prevalence of hypertension was 2.2%. Some 8.5% of mothers and 12.9% of fathers reported to be hypertensive. Maternal history of hypertension (odds ratio 2.0, 95% confidence interval 1.2-3.3) and paternal history of hypertension (odds ratio 2.2, 95% confidence interval 1.4-3.6) were independent risk factors for hypertension in children. Nevertheless, the sensitivity of parental history of hypertension for the identification of hypertension in children was low (from 4% for both parents' positive history up to 41% for at least one parent's positive history). Positive predictive values were also low (between 4 and 5%). Children with hypertensive parents were at higher risk of hypertension. Nevertheless, parental history of hypertension helped only marginally to identify hypertension in offspring. Targeting screening only toward children with a parental history of hypertension may not be a substantially better strategy to identify hypertension in children compared with universal screening.
    Journal of Hypertension 03/2015; 33(6). DOI:10.1097/HJH.0000000000000560 · 4.72 Impact Factor
  • Arnaud Chiolero ·

    Epidemiology (Cambridge, Mass.) 03/2015; 26(2):163-4. DOI:10.1097/EDE.0000000000000235 · 6.20 Impact Factor
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    ABSTRACT: Overdiagnosis is the diagnosis of an abnormality that is not associated with a substantial health hazard and that patients have no benefit to be aware of. It is neither a misdiagnosis (diagnostic error), nor a false positive result (positive test in the absence of a real abnormality). It mainly results from screening, use of increasingly sensitive diagnostic tests, incidental findings on routine examinations, and widening diagnostic criteria to define a condition requiring an intervention. The blurring boundaries between risk and disease, physicians' fear of missing a diagnosis and patients' need for reassurance are further causes of overdiagnosis. Overdiagnosis often implies procedures to confirm or exclude the presence of the condition and is by definition associated with useless treatments and interventions, generating harm and costs without any benefit. Overdiagnosis also diverts healthcare professionals from caring about other health issues. Preventing overdiagnosis requires increasing awareness of healthcare professionals and patients about its occurrence, the avoidance of unnecessary and untargeted diagnostic tests, and the avoidance of screening without demonstrated benefits. Furthermore, accounting systematically for the harms and benefits of screening and diagnostic tests and determining risk factor thresholds based on the expected absolute risk reduction would also help prevent overdiagnosis.
    Swiss medical weekly: official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology 01/2015; 145:w14060. DOI:10.4414/smw.2015.14060 · 2.09 Impact Factor
  • Valérie Santschi · Grégoire Wurzner · Arnaud Chiolero ·

    Blood Pressure Monitoring 12/2014; 19(6):371. DOI:10.1097/MBP.0000000000000073 · 1.53 Impact Factor
  • Arnaud Chiolero ·

    BMJ Clinical Research 11/2014; 349(nov25 17):g7078. DOI:10.1136/bmj.g7078 · 14.09 Impact Factor
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    A Chiolero ·
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    ABSTRACT: Journal of Human Hypertension is exclusively concerned with all clinical aspects of human hypertension. The journal publishes fully refereed original research papers from around the world.
    Journal of Human Hypertension 10/2014; 29(4). DOI:10.1038/jhh.2014.96 · 2.70 Impact Factor
  • Arnaud Chiolero · Nicolas Rodondi ·

    JAMA Internal Medicine 08/2014; 174(10). DOI:10.1001/jamainternmed.2014.4197 · 13.12 Impact Factor
  • Arnaud Chiolero · Jay S Kaufman ·

    The Lancet 06/2014; 383(9934):2042. DOI:10.1016/S0140-6736(14)60990-9 · 45.22 Impact Factor
  • Arnaud Chiolero · Fred Paccaud · Luc Fornerod ·
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    ABSTRACT: Objective: To describe the goals and methods of contemporary public health surveillance and to present the activities of the Observatoire Valaisan de la Santé (OVS), a tool unique in Switzerland to conduct health surveillance for the population of a canton. Methods: Narrative review and presentation of the OVS. Results: Public health surveillance consists of systematic and continuous collection, analysis, interpretation and dissemination of health data necessary for public health planning. Surveillance is organized according to contemporary public health issues. Switzerland is currently in an era dominated by chronic diseases due to ageing of the population. This "new public health" era is also characterized by the growing importance of health technology, rational risk management, preventive medicine and health promotion, and the central role of the citizen/patient. Information technologies provide access to new health data, but public health surveillance methods need to be adapted. In Switzerland, health surveillance activities are conducted by several public and private bodies, at federal and cantonal levels. The Valais canton has set up the OVS, an integrative, regional, and reactive system to conduct surveillance. Conclusion: Public health surveillance provides information useful for public health decisions and actions. It constitutes a key element for public health planning.
    Santé Publique 06/2014; 26(1):75-84. · 0.28 Impact Factor
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    ABSTRACT: Objective Although dual-energy X-ray absorptiometry (DEXA) is the preferred method to estimate adiposity, body mass index (BMI) is often used as a proxy. However, the ability of BMI to measure adiposity change among youth is poorly evidenced. This study explored which metrics of BMI change have the highest correlations with different metrics of DEXA change. Methods Data were from the Quebec Adipose and Lifestyle Investigation in Youth cohort, a prospective cohort of children (8–10 years at recruitment) from Québec, Canada (n=557). Height and weight were measured by trained nurses at baseline (2008) and follow-up (2010). Metrics of BMI change were raw (ΔBMIkg/m2), adjusted for median BMI (ΔBMIpercentage) and age-sex-adjusted with the Centers for Disease Control and Prevention growth curves expressed as centiles (ΔBMIcentile) or z-scores (ΔBMIz-score). Metrics of DEXA change were raw (total fat mass; ΔFMkg), per cent (ΔFMpercentage), height-adjusted (fat mass index; ΔFMI) and age-sex-adjusted z-scores (ΔFMz-score). Spearman's rank correlations were derived. Results Correlations ranged from modest (0.60) to strong (0.86). ΔFMkg correlated most highly with ΔBMIkg/m2 (r = 0.86), ΔFMI with ΔBMIkg/m2 and ΔBMIpercentage (r = 0.83–0.84), ΔFMz-score with ΔBMIz-score (r = 0.78), and ΔFMpercentage with ΔBMIpercentage (r = 0.68). Correlations with ΔBMIcentile were consistently among the lowest. Conclusions In 8–10-year-old children, absolute or per cent change in BMI is a good proxy for change in fat mass or FMI, and BMI z-score change is a good proxy for FM z-score change. However change in BMI centile and change in per cent fat mass perform less well and are not recommended.
    Archives of Disease in Childhood 05/2014; 99(11). DOI:10.1136/archdischild-2013-305163 · 2.90 Impact Factor
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    ABSTRACT: In contrast to obesity, information on the health risks of underweight is sparse. We examined the long-term association between underweight and mortality by considering factors possibly influencing this relationship. We included 31,578 individuals aged 25-74 years, who participated in population based health studies between 1977 and 1993 and were followed-up for survival until 2008 by record linkage with the Swiss National Cohort (SNC). Body Mass Index (BMI) was calculated from measured (53% of study population) or self-reported height and weight. Underweight was defined as BMI < 18.5kg/m2. Cox regression models were used to determine mortality Hazard Ratios (HR) of underweight vs. normal weight (BMI 18.5- < 25.0kg/m2). Covariates were study, sex, smoking, healthy eating proxy, sports frequency, and educational level. Underweight individuals represented 3.0% of the total study population (n = 945), and were mostly women (89.9%). Compared to normal weight, underweight was associated with increased all-cause mortality (HR: 1.37; 95%CI: 1.14-1.65). Increased risk was apparent in both sexes, regardless of smoking status, and mainly driven by excess death from external causes (HR: 3.18; 1.96-5.17), but not cancer, cardiovascular or respiratory diseases. The HR were 1.16 (0.88-1.53) in studies with measured BMI and 1.59 (1.24-2.05) with self-reported BMI. The increased risk of dying of underweight people was mainly due to an increased mortality risk from external causes. Using self-reported BMI may lead to an overestimation of mortality risk associated with underweight.
    BMC Public Health 04/2014; 14(1):371. DOI:10.1186/1471-2458-14-371 · 2.26 Impact Factor
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    Arnaud Chiolero · Pascal Bovet · George S. Stergiou ·

    Journal of Clinical Hypertension 04/2014; 16(6). DOI:10.1111/jch.12315 · 2.85 Impact Factor

Publication Stats

2k Citations
663.90 Total Impact Points


  • 2009-2015
    • McGill University
      • Department of Epidemiology, Biostatistics and Occupational Health
      Montréal, Quebec, Canada
  • 2004-2015
    • University Hospital of Lausanne
      • Institut universitaire de médecine sociale et préventive
      Lausanne, Vaud, Switzerland
  • 2008-2013
    • University of Lausanne
      • Institute of Social and Preventive Medicine
      Lausanne, Vaud, Switzerland
  • 1998-2002
    • Policlinique Médicale Universitaire Lausanne
      Lausanne, Vaud, Switzerland