The Relationship Between Earlobe Creases and the Presence, Extent, and Severity of Coronary Artery Atherosclerosis

Abstract

W e read with great interest and enthusiasm the regional population-based autopsy study "The relationship between earlobe creases and the presence, extent, and severity of coronary artery atherosclerosis" by French et al 1 published in the January issue of this esteemed journal. We commend the authors for publishing this essential work with a meticulous description in a logical manner. However, as a supplement, we would like to add a few suggestions and relevant insights that may be of potential interest to your readers.The association between earlobe crease(s) and coronary artery atherosclerosis has been under debate for ages. 2,3 It is a well-known observation that most of the studies fail to control for the important confounders (which by definition influence both the independent variable of interest, ie, the ear lobe crease, and the outcome variable, ie, coronary artery atherosclerosis in this case) such as age, sex, race, and body mass index (BMI). 1 Consequently, the authors aimed to assess if there is a true association between the ear lobe crease and coronary artery atherosclerosis, in a postmortem setting, using a retrospective subgroup analysis among male, female, European, non-European, and all BMI categories. By demonstrating a statistically significant association across all subgroups, the authors have concluded that there is an association between the ear lobe crease and coronary artery atherosclerosis. Furthermore, we would suggest that in addition to the subgroup analysis that the authors aptly implemented, performing a multivariate logistic regression model, 4 by assessing the association between coronary artery atherosclerosis (as an outcome variable) and the ear lobe crease (independent predictor variable of interest), in combination with the confounders such as age, sex, ethnicity, and BMI, can further offer important facts. A statistically significant "beta coefficient or slope" of "ear lobe crease" in such a model would and scrupulous data analysis on the biomedical research.