A five-year risk prediction model of cardiovascular disease in individuals with bipolar disorder: a nationwide register study from Sweden

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Maja Dobrosavljevic - , Örebro University (Author)
  • Mikael Landén - , Karolinska Institutet (Author)
  • Isabell Brikell - , Aarhus University (Author)
  • Zheng Chang - , Karolinska Institutet (Author)
  • Ralf Kuja-Halkola - , Karolinska Institutet (Author)
  • Paul Lichtenstein - , Karolinska Institutet (Author)
  • Pontus Andell - , Karolinska University Hospital (Author)
  • Ole A Andreassen - , Oslo University Hospital Rikshospitalet (Author)
  • Michael Bauer - , Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Dresden (Author)
  • Rosa Corcoy - , CIBER - Bioengineering, Biomaterials and Nanomedicine (Author)
  • Giovanni de Girolamo - , IRCCS Centro San Giovanni di Dio Fatebenefratelli - Brescia (Author)
  • Andreas Reif - , University Hospital Frankfurt (Author)
  • Henrik Larsson - , Karolinska Institutet (Author)
  • Miguel Garcia-Argibay - , Hampshire and Isle of Wight Healthcare NHS Foundation Trust (Author)

Abstract

Cardiovascular disease (CVD) risk prediction models for the general population may not provide accurate predictions in individuals with bipolar disorder (BD) who have elevated risks of cardiometabolic conditions and premature mortality. Therefore, we aimed to: 1) develop a five-year CVD risk prediction model in this population by using nationwide register data from Sweden, 2) investigate whether the performance improved when we considered additional risk factors, including psychiatric comorbidity, psychotropic medication, and socio-demographic variables, compared to using established CVD risk factors only, and 3) whether machine learning approach provided improvements compared to standard logistic regression models. We followed 33,933 persons with BD aged 30-82 years old, without previous CVD, from the date of BD diagnosis registered between 2007-2014, for up to five years. The logistic regression model containing only established risk factors yielded an area under the receiver operating characteristic curve (AUC) of 0.76 (95% confidence interval 0.74-0.78) in the test dataset, while the logistic regression model and the best performing machine learning model including additional predictors yielded similar results (AUC was 0.77 (0.75, 0.79) in both models). The performance of logistic regression models slightly improved with additional predictors when continuous risk scores were used. In conclusion, standard logistic regression and established CVD risk factors may be sufficient to predict CVD in individuals with BD when using population register-based data from Sweden. External validation across diverse healthcare settings and rigorous assessment of clinical impact will be crucial next steps before implementing these models in clinical practice.

Details

Original languageEnglish
Pages (from-to)2489–2497
Number of pages9
JournalMolecular psychiatry
Volume31
Issue number5
Early online date19 Dec 2025
Publication statusPublished - May 2026
Peer-reviewedYes

External IDs

Scopus 105025584722
ORCID /0000-0002-2666-859X/work/204618381

Keywords

Sustainable Development Goals