The Association between Earlobe Creases and Cardiovascular Events in Japanese Hemodialysis Patients: A Prospective Cohort Study

Abstract

Objective The earlobe crease, a wrinkle extending from the tragus to the outer border of the earlobe, is a well-known surrogate marker for a high risk of cardiovascular disease. However, information is lacking about its association with cardiovascular events among hemodialysis patients, who already have an increased risk of cardiovascular disease. We tested the hypothesis that earlobe creases are independently associated with the risk of cardiovascular events among Japanese hemodialysis patients. Methods This prospective cohort study followed 247 adult hemodialysis patients with no history of cardiovascular disease for 4 years. The presence of earlobe creases was defined by two researchers using photos of patients' earlobes on both sides while blinded to one another's assessments and clinical data. The primary outcome was defined as the first fatal or nonfatal cardiovascular event (myocardial infarction, ischemic or hemorrhagic stroke, or peripheral vascular disease requiring aortic or peripheral vascular bypass surgery or below-or above-the-knee amputation). A Fine-Gray competing risks regression model was used to examine the association between earlobe creases and cardiovascular events. Results During the 4-year follow-up period, 43 patients suffered cardiovascular events. After the competing risk of non-cardiovascular death was accounted for, patients with earlobe creases had an increased cumulative incidence of cardiovascular events compared to those without earlobe creases (subhazard ratio =2.04, 95% confidence interval: 1.09 to 3.82). This association was no longer significant after adjusting for age. Conclusion Earlobe creases were not independently associated with cardiovascular events among Japanese hemodialysis patients, suggesting that these marks are simply indicative of advanced age.

Earlobe crease as a marker of coronary heart disease: a systematic review

“…Two studies also reported that the AUC value of traditional risk factors for CHD was increased by adding the presence of ELC. 5,6 Most studies used high-risk CHD patients as research subjects, but Wakasugi et al 20 used patients who were undergoing hemodialysis and reported conflicting results. Based on a four-year prospective cohort study, patients undergoing hemodialysis with ELC had increased cardiovascular disease incidence compared to patients without ELC.…”

“…Substantial differences in traditional risk factors between hemodialysis patients and the non-dialysis population might influence the results. Wakasugi et al 20 reported that ELC was only a sign of ageing.…”

“…[4][5][6][7]17,18 Fourth, nine studies adjusted for confounding such as age, gender, and other risk factors for atherosclerosis in statistical analyses. [4][5][6][7]12,[17][18][19][20] Overall results of studies TABLE 1 displays the features of the included studies. A total of 19 studies showed that ELC was significantly associated with CHD.…”

“…A total of 19 studies showed that ELC was significantly associated with CHD. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] All of these studies reported that the prevalence of the presence of ELC was significantly higher in CHD patients. Kamal et al 22 reported that patients with bilateral or unilateral ELC were 5.63 times more likely to develop CHD.…”