During the UK Biobank imaging assessment we ask participants aged over 60 if they will wear a heart monitor for two weeks. This is to measure the occurrence of atrial fibrillation, a common heart disorder that increases the risks for blood clots, heart failure and stroke, all of which could be fatal. Scientists have already used some of this data along with information from other studies to pinpoint 150 genes linked to this disorder – paving the way for better treatments. By detecting atrial fibrillation in its early stages, it could be possible to avoid severe consequences including stroke and heart failure.
You can see read published papers using imaging data on the main UK Biobank website: published papers
View more details on the heart monitor we may ask some participants to wear here: heart monitor
25 Dec 2018
UK Biobank thanks participants for their continued support of this pioneering study.
Two major publications in the prestigious journal Nature this week focus on the way that UK Biobank genetics and imaging data are transforming health research.
In one paper, researchers report on a pioneering study that combined 10,000 UK Biobank MR brain images with genetics data from all 500,000 participants.
They found a genetic link for some of the most fundamental processes that allow us to think, act and function, from the size of the parts of the central nervous system that control sight, hearing, speech, emotions and actions to the integrity of the communications channels between them and the strength of the signals within. The results will provide a huge impetus to new research for a wide range of degenerative and psychiatric disorders and ultimately improve treatments.
The work is funded primarily by the Medical Research Council (MRC) and the Wellcome Trust.
“We have had a tantalising glimpse of what could be,” said Professor Steve Smith, Oxford University, who led the study. “These game-changing data stored within the UK Biobank resource, and growing in size and value all the time, will revolutionise our understanding of complex brain disorders.” With 20,000 more participants already scanned and 70,000 still to go UK Biobank would transform understanding.
In particular, the researchers studied 3,144 different measures of brain structure and function, resulting in the discovery of more than 100 areas of the human genome that influence the brain:
There was praise for the work from UKRI Chief Executive Professor Sir Mark Walport, and Sara Marshall Head of Clinical Research and Physiological Sciences at Wellcome. “The research published today brings together a combination of genetic and brain imaging data at an unparalleled scale, and allows us to ask questions about common brain disorders such as Parkinson’s disease, depression and Alzheimer’s disease in a completely new way,” she said.
“Thanks to the vision of UK Biobank’s funders, the altruism of the study participants and the contributions of a large number of scientists who have helped us along the way, UK Biobank is coming of age as a force in health research,” Professor Rory Collins, UK Biobank Principal Investigator said.
View the paper in Nature:
26 Nov 2018
Researchers have found that people exposed to air pollution levels well within UK guidelines have changes in the structure of the heart, similar to those seen in the early stages of heart failure. The research was part-funded by the British Heart Foundation (BHF) and is published in the journal Circulation. 
A team of scientists, led from Queen Mary University of London by Professor Steffen Petersen, studied data from around 4,000 participants in the UK Biobank study. Researchers accessed information provided on their lifestyles, health records and details on where they have lived, so the research team were able to remove patients with underlying heart problems, or those who had moved house during the study. Heart MRI (magnetic resonance imaging) was used to measure the size, weight and function of the participants’ hearts at fixed times. 
Even though most participants lived outside major UK cities, there was a clear association between those who lived near loud, busy roads, and were exposed to nitrogen dioxide (NO2) or PM2.5 - small particles of air pollution – and the development of larger right and left ventricles in the heart. The ventricles are important pumping chambers in the heart and, although these participants were healthy and had no symptoms, similar heart remodelling is seen in the early stages of heart failure.
Higher exposures to the pollutants were linked to more significant changes in the structure of the heart. For every 1 extra µg per cubic metre of PM2.5 and for every 10 extra µg per cubic metre of NO2, the heart enlarges by approximately 1%.
Air pollution is now the largest environmental risk factor linked to deaths in England. Globally, coronary heart disease and stroke account for approximately six in ten (58%) deaths related to outdoor air pollution. This research could help explain exactly how and why air pollution affects the heart.
In the study, average annual exposures to PM2.5 (8-12µg per cubic metre) were well within UK guidelines (25µg per cubic metre), although they were approaching or past World Health Organisation (WHO) guidelines (10µg per cubic metre). The WHO has said that there are no safe limits of PM2.5. The participants’ average exposure to NO2 (10-50µg per cubic metre) was approaching and above the equal WHO and UK annual average guidelines (40µg per cubic metre).
Dr Nay Aung who led the data analysis from Queen Mary University of London said: “Although our study was observational and hasn’t yet shown a causal link, we saw significant changes in the heart, even at relatively low levels of air pollution exposure. Our future studies will include data from those living in inner cities like Central Manchester and London, using more in-depth measurements of heart function, and we would expect the findings to be even more pronounced and clinically important.
“Air pollution should be seen as a modifiable risk factor. Doctors and the general public all need to be aware of the their exposure when they think about their heart health, just like they think about their blood pressure, their cholesterol and their weight.”
Mya Steer, 19, lives just outside Bristol, she was diagnosed with an inherited heart condition, arrhythmogenic right ventricular cardiomyopathy (ARVC) just after her 18th birthday: “My heart condition means that I often struggle to breathe anyway and air pollution makes me feel much worse – it’s pretty instant. This research just goes to show that pollution is affecting us all, whether we live in busy cities or more rural areas where we might feel ‘protected’ from pollution.
“There is no safe limit for air pollution for me, or for anyone who is concerned about their heart health – we all need the Government to do more.”
Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation, which part-funded the study said: “We can’t expect people to move home to avoid air pollution – Government and public bodies must be acting right now to make all areas safe and protect the population from these harms.
“What is particularly worrying is that the levels of air pollution, particularly PM2.5, at which this study saw people with heart remodelling are not even deemed particularly high by the UK Government – this is why we are calling for the WHO guidelines to be adopted. They are less than half of UK legal limits and while we know there are no safe limits for some forms of air pollution, we believe this is a crucial step in protecting the nation’s heart health.
“Having these targets in law will also help to improve the lives of those currently living with heart and circulatory diseases, as we know they are particularly affected by air pollution.”
This research was a collaboration between Queen Mary University of London and the University of Oxford.
1. Association between ambient air pollution and cardiac morpho-functional phenotypes: Insights from the UK Biobank population imaging study, Aung et al.
2. Ejection fraction is used as a measure of heart function
26 Nov 2018
An MRI-based measure, corrected T1 (cT1), could be used as a potential biomarker for liver health, a study in collaboration with Massachusetts General Hospital, Perspectum Diagnostics and the University of Westminster has found.
This image shows a patient with cT1 in the normal range and low liver fat. This has been quantified using LiverMultiScan.
This study involved over 2,800 subjects from the UK BioBank MRI imaging study. The paper has revealed a tight distribution of cT1 values in a sub-population at low risk for non-alcoholic fatty liver disease. In comparison, the cT1 values were significantly elevated in 'higher-risk' sub-populations.
With the burgeoning obesity epidemic, the prevalence of both Non-Alcoholic Fatty Liver Disease (NAFLD), the build-up of fat in the liver, and Non-Alcoholic Steatohepatitis (NASH) inflammation in the liver, are rapidly increasing. Liver disease, including NAFLD and NASH, is usually asymptomatic until the development of cirrhosis, therefore it is critical to identify individuals who are risk and enable early diagnosis. In order to establish which populations are at risk, normality and abnormality need to be ascertained in the context of NAFL and NASH.
Of the population studied, only 37% of participants were classified as being at 'low risk' of NAFLD, i.e. those with a BMI under 25kg/m2and liver fat under 5%. Perspectum Diagnostics' proprietary technology, LiverMultiScan™ was used to calculate the patients' cT1 values. In separate research studies this novel imaging biomarker has been shown to correlate with histology and to predict prognosis (Banerjee, 2014; Pavlides, 2016). The results in this paper showed a tight distribution in the low-risk group, which can act as a baseline comparator in the diagnosis of patients with suspected NAFLD and NASH. The excellent intra-rater and inter-rater reproducibility observed in this study for cT1 provides further support for its utility. Separate research (Pavlides, 2017) has shown that cT1 can distinguish between NAFL and NASH, increasing its utility and adding value to a fat content measure alone to assess fatty liver disease.
Professor Stefan Neubauer, Chief Medical Officer at Perspectum Diagnostics, commented that, "Currently patients with suspected liver disease are biopsied which can cause great pain and distress, and there is a big need for a non-invasive biomarker to enable better care of patients. This study establishes a tight normal range for cT1 in a large low-risk population, an important pre-requisite for an imaging biomarker that can an aid early diagnosis and, hopefully, will reduce the number of patients who are unnecessarily biopsied."
LiverMultiScan corrects for the amount of iron in the liver, as high iron levels can distort the magnetic field and obscure the readings. In this population 36.5% of subjects had sufficiently high iron concentration in their livers to necessitate correction, emphasizing the importance of this method. Iron correction was also needed in cases of mild iron overload that in itself does not pose a clinical problem.
This paper includes an appendix of interesting case studies taken from the Patient Understanding of LiverMultiScan trial and from Massachusetts General Hospital, these case studies show the use of LiverMultiScan and cT1 across a variety of diseases. Dr Amirkasra Mojtahed from the Division of Abdominal Imaging at Massachusetts General Hospital, Boston stated that, "As we move into the era of personalized medicine, it is increasingly becoming important to develop quantitative imaging biomarkers that are uniform across various vendor platforms. This study is an important step in the path for developing a standardized imaging biomarker for liver health and has the potential to replace some of the inherently subjective current methods of assessing liver health."
This manuscript adds to the growing literature on T1 mapping in the liver and displays, for the first time, the reference range of cT1 values in a large population at low risk for NAFL, therefore demonstrating its potential as a biomarker for future studies.
Read the published paper:
26 Nov 2018
Thank you to all the participants who have attended an imaging visit so far. If you would like to find out more about the UK Biobank Imaging Study please visit the imaging website:
Imaging researchers react to this milestone:
This globally important resource permits a unique opportunity for world-leading multidisciplinary discovery science, uniquely facilitating analyses across multiple organ systems, combining detailed mechanistic information with the comprehensive imaging, and places the UK at the forefront of biomedical science internationally.
Professor Nick Harvey, Southampton University
It already is 5x larger than the largest population research imaging study conducted anywhere in the world to date. Such size is essential for gaining sufficient sensitivity to make out the “signatures” of diseases that affect the older UK population well before they happen, when they still can be prevented.
Paul M. Matthews, OBE, MD, DPhil, FRCP, FMedSci
Edmond and Lily Safra Chair, Division of Brain Sciences, Associate Director, UK Dementia Research Institute
Imperial College London
In the first 25,000 UK Biobank imaging participants, we’ll have scanned 500 people who go on to receive a diagnosis of Alzheimer’s by 2022. This will enable us to identify the signatures of dementia in the brain before individuals begin to get sick.
Professor Karla Miller, FMRIB
Factors that influence the health of our blood vessels, such as smoking, high blood and pulse pressures, obesity and diabetes, are linked to less healthy brains, according to research published in the European Heart Journal today.
The study examined the associations between seven vascular risk factors and differences in the structures of parts of the brain. The strongest links were with areas of the brain known to be responsible for our more complex thinking skills, and which deteriorate during the development of Alzheimer’s disease and dementia.
The researchers, led by Dr Simon Cox, a senior research associate at the Centre for Cognitive Ageing and Cognitive Epidemiology at the University of Edinburgh (UK), examined MRI scans of the brains of 9,772 UK Biobank participants, aged between 44 and 79. All had been scanned by a single scanner in Cheadle, Manchester, and most of the participants were from the north-west of England. This is the world’s largest single-scanner study of multiple vascular risk factors and structural brain imaging.
The researchers looked for associations between brain structure and one or more vascular risk factors, which included smoking, high blood pressure, high pulse pressure, diabetes, high cholesterol levels, and obesity as measured by body mass index (BMI) and waist-hip ratio. These have all been linked to complications with the blood supply to the brain, potentially leading to reduced blood flow and the abnormal changes seen in Alzheimer’s disease.
They found that, with the exception of high cholesterol levels, all of the other vascular risk factors were linked to greater brain shrinkage, less grey matter (tissue found mainly on the surface of the brain) and less healthy white matter (tissue in deeper parts of the brain). The more vascular risk factors a person had, the poorer was their brain health.
Dr Cox said: “The large UK Biobank sample allowed us to take a comprehensive look at how each factor was related to many aspects of brain structure. We found that higher vascular risk is linked to worse brain structure, even in adults who were otherwise healthy. These links were just as strong for people in middle-age as they were for those in later life, and the addition of each risk factor increased the size of the association with worse brain health.
“Importantly, the associations between risk factors and brain health and structure were not evenly spread across the whole brain; rather, the areas affected were mainly those known to be linked to our more complex thinking skills and to those areas that show changes in dementia and ‘typical’ Alzheimer’s disease. Although the differences in brain structure were generally quite small, these are only a few possible factors of a potentially huge number of things that might affect brain ageing.”
Smoking, high blood pressure and diabetes were the three vascular risk factors that showed the most consistent associations across all types of brain tissue types measured. High cholesterol levels were not associated with any differences in the MRI scans.
To quantify the size of the differences they observed, Dr Cox explained: “We compared people with the most vascular risk factors with those who had none, matching them for head size, age and sex. We found that, on average, those with the highest vascular risk had around 18ml, or nearly 3%, less volume of grey matter, and one-and-a-half times the damage to their white matter – the brain’s connective tissue – compared to people who had the lowest risk; 18ml is slightly more than a large tablespoon-full, or a bit less than a small, travel-sized toothpaste tube.”
He said that the findings showed the potential of making lifestyle changes to improve brain and cognitive ageing.
“Lifestyle factors are much easier to change than things like your genetic code – both of which seem to affect susceptibility to worse brain and cognitive ageing. Because we found the associations were just as strong in mid-life as they were in later life, it suggests that addressing these factors early might mitigate future negative effects. These findings might provide an additional motivation to improve vascular health beyond respiratory and cardiovascular benefits.”
Limitations of the study include the fact that it does not include people over the age of 79 and that UK Biobank participants tend to live in less deprived areas, which may restrict how the findings can be generalised to other populations. As the researchers were measuring brain structures only, and were not carrying out functional brain imaging or tests of thinking skills, they cannot show in this study how the changes in brain structure might impact cognitive function, but other studies have shown the relationship between increased numbers of vascular risk factors and worse or declining thinking skills, and dementia.
Now the researchers plan to measure the links between vascular risk factors and thinking skills in the UK Biobank participants and in other groups too. In addition, they are following older people, and carrying out multiple scans and tests of thinking skills. They hope this will tell them more about the role that vascular risk factors play in the decline of different types of thinking skills and which areas of the brain are implicated. They also hope that the findings will motivate future work to understand the biological mechanisms through which different sources of vascular risk might be related to different brain areas and tissues.
Go to the UK Biobank website
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