Do Earlobe Creases Really Signal Heart Disease Risk?
A diagonal crease on the earlobe, called Frank's Sign, has been linked to heart disease in hospital patients, but whether it actually predicts cardiovascular risk in healthy people remains unclear.
Assoc. Prof. Dr. Jetsada Denfung Boripath from Chulalongkorn University's Faculty of Science has addressed questions about whether a diagonal crease on the earlobe truly indicates heart disease risk. The crease is formally called Frank's Sign or diagonal earlobe crease (DELC), named after cardiologist Sanders T. Frank, who first observed it in 20 angina patients.
Multiple research studies have found a connection between DELC and cardiovascular disease risk, including coronary artery stenosis, peripheral artery disease, and atherosclerosis. Clinical experience shows the sign is frequently observed in cardiology patients, particularly those who have undergone coronary artery bypass surgery. Hospital-based studies have confirmed the link between DELC and cardiovascular disease among hospitalized patients.
However, the connection remains debated. When reversed—examining asymptomatic individuals with DELC—it is unclear whether they face genuine risk of severe cardiovascular disease. Notably, the link does not appear clearly in diabetic populations, and some studies show the association lacks statistical significance.
The exact cause of DELC is unknown. Some reports suggest micro-vascular disease in the earlobe, while others point to shortened telomeres in Japanese metabolic syndrome patients as a mechanism of aging and atherosclerosis. DELC severity is now classified by length, depth, bilaterality, and angle: unilateral incomplete (least severe), unilateral complete (moderate), and bilateral complete (most severe). However, this classification does not necessarily correlate with increased cardiovascular events.
Interestingly, even notable public figures have been observed with DELC, including former U.S. President George W. Bush and filmmaker Steven Spielberg.
