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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\u201382 years old, without previous CVD, from the date of BD diagnosis registered between 2007\u20132014, 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\u20130.78) 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.<\/jats:p>","DOI":"10.1038\/s41380-025-03381-7","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T13:59:38Z","timestamp":1766152778000},"page":"2489-2497","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A five-year risk prediction model of cardiovascular disease in individuals with bipolar disorder: a nationwide register study from Sweden"],"prefix":"10.1038","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3887-9669","authenticated-orcid":false,"given":"Maja","family":"Dobrosavljevic","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4496-6451","authenticated-orcid":false,"given":"Mikael","family":"Land\u00e9n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabell","family":"Brikell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3765-2067","authenticated-orcid":false,"given":"Ralf","family":"Kuja-Halkola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3037-5287","authenticated-orcid":false,"given":"Paul","family":"Lichtenstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2759-1379","authenticated-orcid":false,"given":"Pontus","family":"Andell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4461-3568","authenticated-orcid":false,"given":"Ole A.","family":"Andreassen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Bauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Corcoy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1611-8324","authenticated-orcid":false,"given":"Giovanni","family":"de Girolamo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0992-634X","authenticated-orcid":false,"given":"Andreas","family":"Reif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Larsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4811-2330","authenticated-orcid":false,"given":"Miguel","family":"Garcia\u2011Argibay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"key":"3381_CR1","doi-asserted-by":"publisher","first-page":"1370","DOI":"10.1001\/jama.2023.18588","volume":"330","author":"AA Nierenberg","year":"2023","unstructured":"Nierenberg AA, Agustini B, K\u00f6hler-Forsberg O, Cusin C, Katz D, Sylvia LG, et al. 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ZC received speaker fees from Takeda Pharmaceuticals, outside the submitted work. OAA is consultant to Precision Health AS and Cortechs, and has received speakers honorarium from Lundbeck, Janssen, Otsuka and Lilly. AR has received honoraria for lectures and\/or advisory boards from Janssen, Boehringer Ingelheim, COMPASS, SAGE\/Biogen, LivaNova, Medice, Shire\/Takeda, MSD and cyclerion. Also, he has received research grants from Medice and Janssen, all outside the submitted work. HL reports receiving grants from Shire Pharmaceuticals; personal fees from and serving as a speaker for Medice, Shire\/Takeda Pharmaceuticals and Evolan Pharma AB; and sponsorship for a conference on attention-deficit\/hyperactivity disorder from Shire\/Takeda Pharmaceuticals and Evolan Pharma AB, all outside the submitted work. HL is editor-in-chief of JCPP Advances. 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