Abstract
Objectives:To investigate the association between diagonal earlobe crease (DELC) and coronary artery disease (CAD). Limited data exists in South Asia and no prior studies have been performed in Pakistan to assess this relationship.Methods:In this case-control study, 200 participants from December 2015 to March 2016 at Shifa International Hospital, Islamabad, Pakistan were enrolled. Consecutive non-probability sampling was used to recruit patients. Cases were enrolled from cardiac care unit (CCU) of the hospital with angiography-proven CAD. Controls were selected from surgical, medical and neurology units of the hospital if they had no previously established evidence or symptoms of CAD. Patients were evaluated in terms of age and any history of hypertension, diabetes and/or smoking. Cases and controls were examined separately by two investigators for the unilateral or bilateral presence of DELC of the lobular portion of either auricle. Patients with ear piercings were excluded from the study. The data was analyzed in statistical product and service solutions (SPSS) (IBM, Delaware, Chicago), and an online statistical software.Results:Out of the 200 patients, 126 (63%) were males and 74 (37%) were females. In the 100 cases, 76 had DELC and 24 had no crease whereas, among the 100 controls, 36 had DELC and 64 had no DELC (p <0.001, OR = 5.63, CI = 2.91-10.93). The prevalence of diseases such as hypertension, diabetes, smoking among the cases and controls were 66%, 53%, 27% and 27%, 18%, 25% respectively. The effect of hypertension and diabetes on the presence of DELC was statistically significant (p <0.05) but the impact of smoking on DELC presence was insignificant (p >0.05).Conclusion:There is a significant association between DELC and CAD. This is the first case-control study from South Asia disclosing this important correlation. Our study also reports a high frequency of DELC in patients suffering from hypertension and diabetes mellitus. No association between smoking and DELC was found.
Highlights
Cardiovascular diseases, including heart disease and stroke, are the world’s largest killers, claiming 17.5 million lives a year globally [1]
In another study done in California, 430 patients were assessed for association between diagonal earlobe crease (DELC) and coronary artery disease (CAD) using coronary computed tomography angiography
To the best of our knowledge, this study is the first report disclosing the correlation of diagonal earlobe crease with coronary artery disease in Pakistani and South Asian population
Summary
Cardiovascular diseases, including heart disease and stroke, are the world’s largest killers, claiming 17.5 million lives a year globally [1]. In Pakistan, coronary heart disease claims about 200,000 lives per year [2]. Diagonal earlobe crease (DELC) has been regarded as a controversial physical sign in predicting the occurrence of CAD. In 1973, Frank first reported the association of the presence of DELC with CAD. It was deemed as the Frank sign [3]. There is no data available to assess this association in the South Asian population, which suffers from an increasingly significant burden of CAD, diabetes mellitus and hypertension. There is a need to carry out further studies in various populations to observe this influence of ethnicity and conclude that this association is applicable to all races [4,5,6,7,8,9]
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