A diagonal ear lobe crease (DELC) is a deep crease or wrinkle that extends down to the earlobe. Some studies suggest that this visible sign is associated with a greater risk for coronary artery disease (CAD), which can cause heart attacks.

Heart attacks or myocardial infarction (MI) occur when the heart muscle becomes damaged due to a lack of blood flow.

CAD is one of the leading causes of mortality worldwide and the most common cause of heart attack.

Visible signs associated with early signs of CAD have been gaining public attention. For example, experts associate earlobe crease with greater CAD risk in the general population, independent of traditional risk factors such as smoking, aging, diabetes, and high blood pressure.

This article explores the association of ear creases with certain heart conditions, their pathophysiology, and more.

Compared to a typical earlobe, some earlobes have a diagonal wrinkle-like crease, line, or deep fold in the lobule of the ear.

The diagonal earlobe crease (DELC) is also called Frank’s sign, named after Dr. Sander T. Frank. Dr. Frank first observed this crease in 20 patients under 60 with chest pain (angina) and proven coronary artery blockages.

In his letter published in the New England Journal of Medicine in 1973, Dr. Frank described a possible association between an earlobe crease and heart disease.

Notable people with this ear crease include Steven Spielberg and George W. Bush. In addition, sculptures of the Roman Emperor Hadrian worldwide display him with earlobe creases. Some believe that he died from CAD and heart failure.

There is no definitive answer on the association between ear creases and heart attacks. Some experts theorize that the underlying process that causes the two are similar.

End-arteries supply the heart and ears. This means that once they lose blood supply, no other arteries can take over, causing damage to the tissue.

One theory suggests that ear lobe crease is associated with the loss of elastin and elastic fibers, the same process that damages blood vessels in CAD.

There is also a link between heart attack and ear creases across different ethnic populations, supporting the idea that a common genetic factor may be involved.

Learn more about coronary artery disease here.

An older study found that appearing older for one’s age may be a marker of poor cardiovascular health. Specifically, visible signs including earlobe crease, male pattern baldness, and cholesterol deposits in the eyes (xanthelasma), whether alone or in combination, are associated with an increased risk of ischemic heart disease and heart attack.

While the exact mechanism linking DELC and CAD still needs further research, a 2016 study stated that DELCs are a simple and feasible way to identify CAD.

The study suggests that DELC is independently associated with a risk of CAD. It also suggested a positive association with age, gender, and smoking status.

A 2017 study found that DELC could predict ischemic cerebrovascular events such as transient ischemic attack (TIA) and stroke.

The research also mentioned that people with Frank’s sign and classical cardiovascular risk factors, namely age, gender, type 2 diabetes, and high blood pressure (hypertension), had a higher risk.

Not only do DELC and CAD risk factors predict the incidence of CAD, but a 2015 study suggested that DELC may also predict CAD’s outlook following a percutaneous coronary intervention (PCI).

Similarly, another 2021 study examining acute MI and DELC and the risk of death found that the earlobe crease is independently associated with 1 year of acute MI survival. In addition, those with an ear lobe crease had a slightly to moderately increased risk of death after acute MI.

However, some research shows contrasting results, but most of these are old studies. A 2008 study stated that earlobe crease is not a significant independent predictor of CAD or retinopathy.

Another older study concluded that the association between DELC and CAD is due to its increasing prevalence with old age.

The underlying mechanism behind the ear lobe crease is not clear. However, numerous studies have evaluated its potential underlying mechanism and its link to CAD.

A 2021 study found that people with earlobe creases and CAD have low adropin and irisin levels, a type of protein, compared to a control group. This deficiency may be the underlying mechanism for DELC and atherosclerosis.

Another 2021 study found that people with earlobe creases had low serum levels of the age-suppressing hormone Klotho. Klotho is a hormone associated with premature aging and endothelial dysfunction. It may also be associated with atherosclerosis.

These mechanisms may explain why people with ear lobe creases are prone to CAD.

In CAD, the coronary arteries that supply blood to the heart muscles narrow and harden due to plaque buildup in its walls.

The condition has no cure and is not reversible. However, a person can make lifestyle changes to prevent it from worsening. Several medicines help treat CAD by widening the arteries or reducing blood pressure.

Doctors may perform interventional procedures or surgery to widen the blood vessel or bypass blocked arteries if medications cannot manage the condition.

Learn more about medication and surgical options for heart disease.

According to the Centers for Disease Control and Prevention (CDC), almost half of all Americans have 1 of 3 key risk factors for heart disease, which are:

Read more about how smoking increases heart disease risk here.

Other classic risk factors of heart disease include:

  • type 2 diabetes
  • obesity
  • a diet high in cholesterol, trans fat, and saturated fat
  • inadequate physical activity
  • smoking
  • heavy drinking
  • family history of heart disease
  • old age

Doctors may request several tests to diagnose CAD:

  • Electrocardiogram: This checks the electrical activity of the heart and can show if the person has had a heart attack.
  • Echocardiogram: This uses sound waves to create pictures of the beating heart. It may show parts of the heart that may be weaker due to heart attack or inadequate oxygen.
  • Exercise stress test: This test measures a person’s heart rate while walking on a treadmill to determine the heart’s ability to pump blood under exertion.
  • Cardiac catheterization: This test uses a thin, flexible tube in the arteries to check for blockages.
  • Coronary angiogram: This test monitors blood flow and blockages in the coronary arteries.
  • Coronary artery calcium scan: A CT scan that checks for calcium deposits and plaque buildup.

If a person notices they have an ear lobe crease, it is worth speaking with a healthcare professional if they are also experiencing symptoms of heart disease or are at risk due to other factors.

Heart disease may be silent, and people may not be aware of them until they experience symptoms.

These symptoms may include:

However, a person requires emergency treatment if they experience any of the following:

  • severe pain or pressure at the center of the chest
  • pain spreads from the chest to the arms, shoulder, and neck
  • chest discomfort with nausea, fainting, or sweating

If these symptoms are present, a person may be having a heart attack. However, heart attack symptoms may be different for every individual. For someone who has worsening symptoms or anything outside the ordinary, it is best to seek medical help.

Many studies link a diagonal earlobe crease on one or both ears — known as Frank’s sign — with a higher risk of cardiovascular conditions such as stroke and heart attack.

While the underlying mechanism that links it with a heart attack is lacking, many studies prove the association. Moreover, using it along with known risk factors can help predict heart attack and even the outlook of specific procedures.

However, people should not rely solely on having an earlobe crease. A person with other risk factors for heart disease must consult a doctor for proper diagnosis and timely management.