Tomas Jernberg

Obesity is associated with type 2 diabetes (T2D) and cardiovascular disease (CVD). Metabolic and bariatric surgery (MBS) has in several randomized controlled trials (RCT) been shown to be superior to best medical therapy in the treatment of T2D. In the area of CVD, RCT after MBS are lacking. We recently demonstrated in a cohort study that MBS in patients with severe obesity and a previous myocardial infarction (MI) was associated with a 50% reduction in the risk of death and new MI. The aim of this proposal is to confirm this in a nationwide RCT. Using the nationwide SWEDEHEART database we will identify patients with serve obesity and a previous MI. They will be contacted and offered participation. After informed consent the patients will be randomized to MBS or optimized care (including visit with a cardiologist and optimization of secondary preventive measures and referral to dietician/physiotherapist). The primary outcome measure is a major cardiovascular adverse event (MACE). Secondary outcome measures include mortality, new MI, stroke, heart failure and atrial fibrillation. Tertiary outcome measures include health related quality of life and surgical complications. Patients will be followed in the nationwide metabolic surgery register SOReg, the national inpatient register, national cause of death register, the Swedish prescribed drug register, and the Swedish population register. If positive results these can be included in guidelines for MBS.

What is important?  Evidence points to substantial comorbidity between adult ADHD and cardiometabolic disease, i.e., obesity, type-2 Diabetes (T2DM), and cardiovascular disease (CVD). Guidelines for care of cardiometabolic disease stress the importance of co-occurring psychiatric disorders, yet ADHD is rarely mentioned. This is problematic as ADHD is a common psychiatric disorder (2–5%) and behaviours and cognitive challenges associated with ADHD may lead to poor outcomes due to poor adherence and risky behaviours. Also, stimulant medications used to treat ADHD may increase risk for adverse outcomes for those with underlying CVD or in interaction with other pharmacological treatments.What is to be done? First, determine how ADHD associates with outcomes (i.e., cardiometabolic risk profiles, adherence to treatments for cardiometabolic disease, and severe post-surgery/diagnosis outcomes) after bariatric surgery, T2DM and CVD diagnosis. Second, explore real-world effectiveness and safety of ADHD medication in relation to cardiometabolic outcomes/treatments. Third, develop prediction tool that allow identification of patients with ADHD at high-risk for poor cardiometabolic outcomes and treatment adherence.How the research will be carried out? An interdisciplinary team of experts will apply state-of-the art statistical approaches and beyond on data from a comprehensive linkage of national registers, including three unique quality registers of bariatric surgery, T2DM and CVD.

Randomized trials do not estimate treatment effects in individuals that were eligible but did not enroll in the trial. However, guidelines established as a result of the trials apply to these populations in clinical practice. On average, around 40% of eligible individuals do not enroll in trials. A treatment that shows no benefit in trial participants may be effective in a subpopulation not likely to enroll, such as older individuals. Differences in effectiveness must be quantified to guide policy decisions. Extending randomized trial results to the treatment eligible population is often handled using real-world data alone, which are prone to bias.This project will propose a novel framework that uses transportability and benchmarking methods to simultaneously utilize data from the TASTE and VALIDATE randomized trials and real-world data from the SWEDEHEART registry to robustly fill the knowledge gaps left by the trials. Specifically, we will estimate the effect of thrombus aspiration and two anticoagulant medications after myocardial infarction in the whole trial-eligible population of Sweden

test the reliability of studies that use real-world data alone to estimate treatment effects

and create tutorials, teaching materials, and open-source code to facilitate the uptake of these methodologies. Our research will improve public health decisions in Sweden and serve as a model in the extension of findings from randomized trials to the population eligible for treatment.

Treatment and survival after a heart attack <br/> <br/> No Research stays abroadCorrect treatment for a heart attack is important to reduce the damage to the heart and improve the long-term prognosis. This study examines whether the treatment given in Norway is in accordance with current recommendations and and to what extent this affects the prognosis Coronary artery disease is an important cause of hospitalization and early death. Treatment during and after a heart attack is recommended in international guidelines. Previous studies may indicate that these are not always followed. <br/> <br/> The study examines whether treatment recommendations for different groups of patients with myocardial infarction are followed, and to what extent compliance with the guidelines is important for survival and morbidity. <br/> < All patients registered in the Norwegian Heart Attack Register 2013-2019 are included in the study. Information from the register is linked to other health registers <br/> <br/> In 2021, we have published articles on the choice of anticoagulant treatment for heart attacks and on differences in the treatment of heart attacks between different European countries. <br/>