Ear lobe crease as a marker of coronary artery disease: A meta-analysis

Lucenteforte, Ersilia; Romoli, Marco; Zagli, Giovanni; Gensini, Gian Franco; Mugelli, Alessandro; Vannacci, Alfredo

doi:10.1016/j.ijcard.2014.04.025

Cited by 48 publications

(41 citation statements)

References 32 publications

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“…3 These data are confirmed by autopsy reports. Frank's sign was most common in Caucasian patients with ischemic heart disease and aortic aneurysms.…”

supporting

confidence: 62%

Are you a rich guy with a diagonal earlobe crease?

Pabisiak¹,

Knop²,

Rynio³

et al. 2017

Polish Archives of Internal Medicine

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CLINICAL IMAGE Are you a rich guy with a diagonal earlobe crease? 557and its complications showed a sensitivity of 62% and specificity of 67%. 3 These data are confirmed by autopsy reports. Frank's sign was most common in Caucasian patients with ischemic heart disease and aortic aneurysms. Its frequency also positively correlates with age. It is not observed in children and young adults. 4 In the early phase of crease formation, it can be seen only after night rest and often disappears during the daytime. The largest prospective study to date (over 10 000 participants) showed that people over 40 years of age with earlobe crease are at risk of vascular disease due to atherosclerosis. 5 In our patient, microcytic anemia was diagnosed. A computed tomography scan of the chest and abdomen revealed continuous extension of thoracic aneurysm and endoleak within the lower part of the stent graft (FIGURE 1B). Abdominal aorta imaging showed formation of pseudoaneurysm within the previous stent grafting area (FIGURE 1C and 1D). The patient received red blood cell transfusion, which led to subjective improvement. After consultation with an interventional radiologist and vascular surgeons, the patient was referred for endovascular aortic repair with implementation of branching stent graft in the abdominal area. A preoperative check-up revealed an albumin level of 37 g/l (reference range, 35-54 g/l), lymphocyte count of 12.8% (20%-45%), C-reactive protein level of 35.6 mg/dl (<5 mg/dl), and the following lipid levels (obtained with atorvastatin treatment at a dose of 40 mg once daily): total cholesterol, 141 mg/dl (<190), high--density lipoprotein cholesterol, 37 mg/dl (>40 mg/dl), and low-density lipoprotein cholesterol, 77 mg/dl (<115 mg/dl). Echocardiography revealed an ejection fraction of 45%. The estimated glomerular filtration rate was 20 ml/min/1.73 m 2 . The Charlson comorbidity index was over 4. Currently, the patient is considering the risk-to-benefit ratio of the recommended approach.A 79-year-old man presented to an internal medicine clinic with a 3-day history of general malaise and abdominal pain at rest. He had a history of hypertension, ischemic heart disease with prior myocardial infarction (2006), and atherosclerosis manifesting as pathological widening of the thoracic and abdominal sections of the aorta. The abdominal part was treated by prosthesis implantation in an open surgery in 2011. The thoracic part was supported by the thoracic endovascular aortic repair in 2013. A physical examination revealed thinning of the skin, numerous ecchymoses and petechiae on the trunk and upper limbs, and dry mucosa. Visible creases on both auricles stemming below the incisura intertragica to the edge of the earlobe were notable. The earlobe fissure described above is known as Frank's sign since 1973. 1 This sign can be referred to, in a more descriptive way, as diagonal earlobe crease, most commonly angled about 45 degrees to the horizontal plane. The minor angle of the crease is possible, and, in such cases, it is call...

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“…3 These data are confirmed by autopsy reports. Frank's sign was most common in Caucasian patients with ischemic heart disease and aortic aneurysms.…”

supporting

confidence: 62%

Are you a rich guy with a diagonal earlobe crease?

Pabisiak¹,

Knop²,

Rynio³

et al. 2017

Polish Archives of Internal Medicine

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“…A recent review of the skin manifestations of atherosclerosis suggests that ELC may be an early marker of atherosclerosis (17). A metaanalysis suggested that ELC may be an early sign of CAD with 67% specificity and 62% sensitivity (18). In spite of these results, no certain statement of etiopathogenesis was determined between ELC and CAD.…”

Section: Discussionmentioning

confidence: 99%

Relationship between the earlobe crease and brain white matter abnormalities in apparently healthy subjects

Korkmaz¹

2019

Turk J Med Sci

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Background/aim: In the present study we aimed to investigate whether the earlobe crease (ELC) might provide predictive information about white matter intensities (WMIs) in the brain that reflect brain aging. Materials and methods:A total of 350 individuals examined from January 2016 to July 2016 were screened. Patients with known demyelinating white matter disease, neurodegenerative disorders, cerebrovascular event history, or brain tumors were excluded from the study. Finally, 285 cases were included in the study. The four-point cerebral intensity classification system of Fazekas was used in the evaluation of the brain. The ELC was evaluated by inspection.Results: A total of 285 patients were enrolled consecutively. The incidence of WMI was significantly higher in patients with ELC than the others. Age (95% CI: 1.105-1.213, P < 0.001) and ELC (95% CI: 0.098-0.783, P = 0.015) were found as an independent determinants of abnormal WMI. ELC predicted abnormal WMIs with 89% specificity and 62% sensitivity. Conclusion:The presence of an ELC may provide predictive information in terms of detecting abnormal WMIs with prognostic impact in apparently healthy subjects.

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“…The literature in general implies that appearing old for one's age is associated with cardiovascular disease and premature death independently of chronological age [1,2,[14][15][16][17][18][19] . Especially earlobe crease, xanthelasmata and male pattern baldness have previously been found to predict cardiovascular disease and death [1,2,[14][15][16][17][18][19] , while there is contradictive evidence to whether arcus corneae is an independent risk factor of cardiovascular disease and death [1,2,20,21] . Given the health benefits of physical activity and that visible age-related signs can be interpreted as a marker for biological age, we hypothesized that a physical activity in leisure time could slow down biological aging and therefore decrease the development of visible age-related signs.…”

Section: Discussionmentioning

confidence: 99%

“…The normal aging process is characterized by progressive stiffening in collagen-rich connective tissues such as skin, cornea, cartilage, lung, and arteries [13] . Some visible age-related signs have been found to predict cardiovascular disease and mortality: earlobe crease (a diagonal fold or wrinkle in the skin of the earlobe) [14][15][16][17] and xanthelasmata (yellow-orange plaques on the eyelids or median canthus) [1,2] . Also, some studies have found that vertex baldness may be a marker for increased risk of coronary heart disease [18,19] , while the evidence regarding arcus corneae (white or gray opaque ring in the corneal margin of eye) as a predictive marker of coronary heart disease and early death is unclear [2,20,21] .…”

mentioning

confidence: 99%

Physical activity and the development of visible age-related signs in the general population: A prospective cohort study

Petersen¹,

Schou²,

Schnohr³

et al. 2018

har

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Background: Physical inactivity is a well-known risk factor for multiple diseases and may be associated with increased aging of the body. Visible age-related signs indicate biological age, as individuals appearing old for their age are more likely to be at poor health, compared with people appearing their actual age. The aim of this study was to test the hypothesis that physical activity is associated with biological aging, indicated by 5 visible age-related signs (arcus corneae, xanthelasmata, earlobe crease, facial wrinkles, and pattern baldness). Materials and Method: We used information from 11,613 individuals in the Copenhagen City Heart Study. Physical activity and other lifestyle factors were assessed prospectively and visible age-related signs were inspected at subsequent examinations. We performed interval censored survival analyses, using a SE allowing for intragroup correlation, as some individuals were included twice. Results: Physical activity was not related to the risk of developing earlobe crease, facial wrinkles or pattern baldness. Among men, but not women, moderate physical activity was associated to a lower risk of developing xanthelasmata compared with inactivity (hazard ratio, 0.68; 95% confidence interval, 0.49-0.95) while among women, vigorous physical activity was associated to a higher risk of arcus cornea (hazard ratio, 1.51; 95% confidence interval, 1.05-2.15). Conclusion: Independent of chronological age, physical activity was not related to visible signs of aging. Aging is a part of a complex multifactorial process. This is the first prospective study to investigate the relation between physical activity level and looking old for your age.

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Ear lobe crease as a marker of coronary artery disease: A meta-analysis

Cited by 48 publications

References 32 publications

Are you a rich guy with a diagonal earlobe crease?

Are you a rich guy with a diagonal earlobe crease?

Relationship between the earlobe crease and brain white matter abnormalities in apparently healthy subjects

Physical activity and the development of visible age-related signs in the general population: A prospective cohort study

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