Anterior Tragal Crease: A Marker of Coronary Artery Disease

Abstract

The prevalence of cardiovascular (CV) disease (CVD), comprising coronary artery disease (CAD), heart failure, stroke, and hypertension in adults 20 years of age is 48.0% overall and increases with age in both males and females. 1 Coronary artery disease (43.2%) is the leading cause of CVD death in the United States, followed by stroke (16.9%), hypertension (9.8%), and heart failure (9.3%). 1 Total CAD prevalence is 6.7% in US adults 20 years of age (7.4% for males and 6.2% for females). 1 It is estimated that by 2030, 40.5% of the US population will have some form of CVD. 2 Traditional CV risk factors include age, hypertension, dyslipidemia, diabetes, smoking, obesity, as well as family history of premature coronary heart disease. Other CVD risk predictors include certain inflammatory and hemostatic markers, endothelial dysfunction, homocysteine, microalbuminuria/proteinuria, coronary artery calcium score, arterial stiffness, inflammatory bowel syndrome, obstructive sleep apnea, impaired glucose metabolism, metabolic syndrome as well as nonalcoholic fatty liver disease. 3 Changes in ear crease have been suggested as potential markers of CAD in numerous studies. 4 These ear crease changes, such as diagonal ear lobe crease (ELC) and anterior tragal crease (ATC) are simple clinical signs easily recognized by general practitioners. This makes ATC and ELC promising signs, in combination with the above risk factors, to identify patients at risk of developing clinical atherosclerosis.