Diagonal earlobe creases and prognosis in patients with suspected coronary artery disease

      This paper is only available as a PDF. To read, Please Download here.


      To determine whether high-risk patients with unilateral, bilateral, or no earlobe creases (ELC) have different prognoses for common sequelae of coronary heart disease.

      Patients and methods

      Two hundred sixty-four consecutive patients from a university-based coronary care unit or catheterization laboratory were blindly followed up for 10 years, using questionnaires, medical records, and death certificates. The primary outcome measure was time to cardiac event; namely, coronary artery bypass graft (CABG), myocardial infarction (MI), or cardiac death. Analyses included log-rank tests and Cox proportional hazards regression modelling.


      The number of creased ears was significantly associated, in a graded fashion, with 10-year cardiac event free survival: 43.5% ±5.7%, 33.0% ± 6.7%, or 17.5% ± 4.6% (mean ±standard error for 0, 1, or 2 ELC, respectively; P = 0.0003). After adjustment for 10 known cardiac risk factors, including age and left ventricular ejection fraction, the relative risk for a cardiac event for a unilateral ELC, relative to 0 ELC, was 1.33 (95% confidence interval [CI] 1.10 to 1.61, P = 0.02), and for bilateral ELC, it was 1.77 (95% CI 1.21 to 2.59, P = 0.003).


      Ear lobe creases are associated, in a graded fashion, with higher rates of cardiac events in patients admitted to hospital with suspected coronary disease. In such patients, ELC may help to identify those at higher risk for sequelae of coronary disease.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Chambless LE
        • Fuchs FD
        • Linn S
        • et al.
        The association of corneal arcus with coronary heart disease and cardiovascular disease mortality in the Lipid Research Clinics Mortality Follow-up Study.
        Am J Pub Health. 1990; 80: 1200-1204
        • Rosenman RH
        • Brank R
        • Sholtz RI
        • Friedman M
        Multivariate prediction of coronary heart disease during 8.5. year follow-up in the Western Collaborative Group Study.
        Am J Cardiol. 1976; 37: 903-910
        • Lesko SM
        • Rosenberg L
        • Shapiro S
        A case-control study of baldness in relation to myocardial infarction in men.
        JAMA. 1993; 269: 1035-1036
        • Elliott WJ
        Ear lobe crease and coronary artery disease: 1000 patients and review of the literature.
        Am J Med. 1983; 75: 1024-1035
        • Brady PM
        • Zive MA
        • Goldberg RJ
        • et al.
        A new wrinkle to the earlobe crease.
        Arch Intern Med. 1987; 147: 65-66
        • Cheng TO
        Earlobe crease and coronary artery disease: association or coincidence?.
        Am J Med. 1992; 93 (Letter): 587-590
        • Doering C
        • Ruhsenberger C
        • Phillips DS
        Ear-lobe creases and heart disease.
        J Am Geriatr Soc. 1977; 25: 183-185
        • Frank ST
        Aural sign of coronary artery disease.
        NEJM. 1973; 289 (Letter): 327-328
        • Elliott WJ
        • Karrison T
        Increased all-cause and cardiac morbidity and mortality associated with the diagonal earlobe crease: a prospective cohort study.
        Am J Med. 1991; 91: 247-254
        • Kaplan EL
        • Meier P
        Nonparametric estimation from incomplete observations.
        J Am Stat Assoc. 1958; 53: 457-481
        • Gross AJ
        • Clark VA
        Survival Distributions: Reliability Applications in the Biomédical Sciences.
        in: Wiley & Sons, New York1975: 54-63
        • Brown Jr, BW
        • Hollander M
        Statistics: A Biomedical Introduction. Wiley & Sons, New York1977: 211-216
        • Concato J
        • Feinstein AR
        • Holford TR
        The risk of determining risk with multivariable models.
        Ann Intern Med. 1993; 118: 201-210
        • Petrakis NL
        • Koo L
        Earlobe crease.
        Lancet. 1980; 1 (Letter): 376
        • Tranchesi Jr, B
        • Barbosa V
        • de Albuquerque CP
        • et al.
        Diagonal earlobe crease as a marker of the presence and extent of coronary atherosclerosis.
        Am J Cardiol. 1992; 70: 1417-1420
        • McCullagh P
        Regression models for ordinal data.
        J Royal Statist Soc. 1980; B42: 109-142
        • Lichstein E
        • Chapman I
        • Gupta PK
        • et al.
        Diagonal ear-lobe crease and coronary artery sclerosis.
        Ann Intern Med. 1976; 85 (Letter): 337-338
        • Ishii T
        • Asuwa N
        • Masuda S
        • et al.
        Earlobe crease and atherosclerosis: an autopsy study.
        J Am Geriatr Soc. 1990; 38: 871-876
        • Patel V
        • Champ C
        • Andrews PS
        • et al.
        Diagonal earlobe creases and ather-omatous disease: a postmortem study.
        J R Coll Physicians Lond. 1992; 26: 274-277
        • Cheng TO
        Diagonal earlobe creases.
        J R Coll Physicians Lond. 1992; 26 (Letter): 460
        • Hu B
        • Zhang J
        • Hong X
        Ear-lobe crease: prevalence and clinical significance.
        Chin J Cardiol. 1988; 16: 21
        • Kenny DJ
        • Gilligan D
        Ear lobe crease and coronary artery disease in patients undergoing coronary arteriography.
        Cardiology. 1989; 76: 293-298
        • Gibson TC
        • Ashikaga T
        The ear lobe crease sign and coronary artery disease in aortic stenosis.
        Clin Cardiol. 1986; 8: 388-390
        • Moraes D
        • McCormack P
        • Tyrrell J
        • Feely J
        Ear lobe crease and coronary heart disease.
        Ir Med J. 1992; 85: 131-132
        • Frank ST
        Ear crease sign of coronary disease.
        NEJM. 1977; 297 (Letter): 282
        • Schoenfeld Y
        • Mor R
        • Weinberger A
        • et al.
        Diagonal ear lobe crease and coronary risk factors.
        J Am Geriatr Soc. 1980; 27: 184-187
        • Toyosaki N
        • Tsuchiya M
        • Hashimoto T
        • et al.
        Earlobe crease and coronary heart disease in Japanese.
        Heart Vessels. 1986; 2: 161-165
        • Gutiu I
        • el Rifai C
        • Mallozi M
        Relation between diagonal ear lobe crease and ischemic chronic heart disease and the factors of coronary risk.
        Med Interne. 1986; 24: 111-116
        • Jorde LB
        • Williams RR
        • Hunt SC
        Lack of association of diagonal earlobe crease with other cardiovascular risk factors.
        West J Med. 1984; 140: 220-223
        • Haft JI
        • Gonella GR
        • Kirtane JS
        • Anastasiades A
        Correlatior of ear-crease sign with coronary arteriographic findings.
        Cardiovasc Med. 1979; 4: 861-867
        • Bernabo JG
        • Rentschler PA
        • Pedemonte NC
        Pliegue diagonal del lobulo de la oreja y enfermedad vascular ateroesclerotica.
        Prensa Méd Argent. 1983; 70: 471-475
        • Pryor DB
        • Shaw L
        • McCants CB
        • et al.
        Value of the history and physical examination in identifying patients at increased risk for coronary artery disease.
        Ann Intern Med. 1993; 118: 81-90
        • Kircher T
        • Anderson RE
        Cause of death: proper completion of the death certificate.
        JAMA. 1987; 258: 349-352
        • Kaukola S
        The diagonal earlobe crease, a physical sign associated with coronary heart disease.
        Acta Med Scand. 1978; 619: 1-49
        • Nyboe J
        • Jensen G
        • Appleyard M
        • Schnohr P
        Risk factors for acute myo-cardial infarction in Copenhagen. I: hereditary, educational socioeconomic factors. Copenhagen City Heart Study.
        Eur Heart J. 1989; 10: 910-916