Ear Lobe Crease and Heart Disease – look in the mirror!

Dr. Weeks’ Comment:   a physical sign like the ear lobe crease can stimulate further questioning and perhaps a cardiovascular work up.  Here are some interesting and conflicting articles on that crease in your ear lobe!

Rom J Intern Med. 1996 Jul-Dec;34(3-4):271-8.

Diagonal earlobe crease: a coronary risk factor, a genetic marker of coronary heart disease, or a mere wrinkle. Ancient Greco-Roman evidence.

Guţiu IA, Galeţescu E, Guţiu LI, Răducu L.

Clinic of Internal Medicine, Griviţa Hospital, Bucharest, Romania.


In a new study on the relationship between the diagonal earlobe crease (DELC), first described by Frank in 1973, and the presence of chronic ischemic heart disease, four main hypotheses are presented. Hypothesis 1: DELC is a coronary risk factor or a marker of coronary risk factor. Hypothesis 2: DELC is a genetic marker of atherosclerotic coronary disease. Hypothesis 3: DELC is, in fact, the result of aging and the relationship with atherosclerotic coronary disease is mere coincidence. Hypothesis 4: DELC is an anatomic peculiarity of the ear lobe, perhaps the result of a particular way of sleeping. These hypotheses are discussed in the light of the most important results obtained so far, in the literature and in the author’s personal studies. Moreover, the data reported by Petrakis, who was the first to mention in 1980 the presence of this sign in some of the Greco-Roman sculptures in the museums of Rome, are corroborated by the observations of one of the authors, made in the Louvre Museum in Paris.


Z Kardiol. 1995 Jul;84(7):512-9.

[The diagonal ear lobe crease for evaluating coronary risk].

[Article in German]

Kuon E, Pfahlbusch K, Lang E.

Medizinische Klinik des Waldkrankenhauses St. Marien Abteilung Kardiologie, Erlangen.


Though the predictive value of a diagonal earlobe crease (ELC) concerning coronary heart disease (CHD) is assessed controversially and seems to be influenced by age and ethnic origin, the ELC is mainly regarded as a reliable and valid sign of CHD. 670 patients, the greatest collective so far undergoing coronary angiography, were investigated prospectively with respect to the correlation between ELC and a hemodynamically relevant CHD (coronary diameter stenosis > 70%). In presence of ELC, CHD was observed in 55.0%, in its absence in 55.9% (One-vessel-disease (1-VD) 25.8% vs 26.7%, 2-VD 14.5% vs 14.4%, > 2-VD 14.8% vs 14.8%; n.s.). ELC itself was dependent on age (p < 0.000009), overweight (body mass index (BMI) > 25 kg/m2, p < 0.034) and hyperuricemia (> 7.0 mg%; p < 0.05), but not influenced by sex and other coronary risk factors such as smoking, diabetes, hypercholesterinemia and hyperlipoidemia, physical in-activity and family history of CHD. Actual just as former smoking and male sex are associated positively to CHD, whereas diabetes, hypercholesterinemia and hyperlipoidemia seem to predict a two-or multivessel disease: this emphasizes the validity of our data. CONCLUSION: The ear-lobe crease is associated with age and overweight, but does not predict a hemodynamically relevant coronary heart disease.


Ir Med J. 1992 Dec;85(4):131-2.

Ear lobe crease and coronary heart disease.

Moraes D, McCormack P, Tyrrell J, Feely J.

Dept of Pharmacology and Therapeutics, Trinity College Medical School, St James’s Hospital, Dublin 8.


  • Two hundred and forty seven consecutive patients admitted to an acute general hospital were studied. The presence of an association between the ear lobe crease (ELC) and ischaemic heart disease, hypertension, hypercholesterolaemia, peripheral vascular disease, cerebrovascular disease and smoking was investigated. The association between an ELC and coronary heart disease was found to be significant. There was no significant difference between the prevalence of ear lobe creases in males versus females and no correlation between ear lobe creases and smoking, hypercholesterolaemia, hypertension, peripheral vascular disease or stroke was found. Despite having a low sensitivity the specificity of an ear lobe crease is 94% which suggests that it should be used as a physical sign predictive of the presence of coronary heart disease rather than a diagnostic test.


Lijec Vjesn. 1990 Jul-Aug;112(7-8):206-7.

[The role of the diagonal ear lobe crease in the clinical evaluation of coronary risk].

[Article in Croatian]

Mirić D, Rumboldt Z, Pavić M, Kuzmanić A, Bagatin J.

KBC Firule Split, Klinika za unutarnje bolesti.


Two hundred and forty-three prospective patients (143 with proved coronary heart disease and 100 without coronary disease) were analysed for the presence or absence of ear lobe crease, a possible aural sign of coronary artery disease. The crease was present in 72.7% of the coronary and 48% of the noncoronary examinees (p less than 0.001). The crease was more prevalent in older (greater than 50) than in the younger patients. The positive predictive value of this sign averages 70% and the negative one 60%.


Cardiology. 1989;76(4):293-8.

Ear lobe crease and coronary artery disease in patients undergoing coronary arteriography.

Kenny DJ, Gilligan D.

Department of Cardiology, Royal City of Dublin Hospital, Ireland.


An association between the ear lobe crease and coronary heart disease has been documented. A prospective study of 125 consecutive patients undergoing coronary arteriography was carried out to evaluate the ear lobe crease with the presence and extent of coronary artery disease. An ear lobe crease was observed in 65 patients, but this trait was not related to age, sex, smoking history, previous myocardial infarction, history of hypertension, family history of heart disease, body mass index or angiographically defined coronary artery disease. We conclude the ear lobe crease is not related to coronary heart disease.


Acupunct Electrother Res. 1989;14(2):149-54.

Diagonal ear-lobe crease: possible significance as cardio-vascular risk factor and its relationship to ear-acupuncture.

Romoli M, Tordini G, Giommi A.

S.I.R.A.A. – Societa Italiana di Riflessoterapia, Agopuntura, Auricoloterapia, Prato, Italy.


The diagonal ear-lobe crease, detectable especially after the age of 40, is still accepted as a sign of coronary heart disease risk. In the literature some authors report an association between anxiety and coronary heart disease. In our work a group of 143 patients with ear-lobe crease showed – in both sexes and in all examined decades (5th, 6th, 7th) – higher levels of anxiety than in the control group. The possible significance of the crease has been considered on the grounds of present knowledge of ear-acupuncture and the somatotopic mapping of CNS on the ear-lobe.


Med Interne. 1986 Apr-Jun;24(2):111-6.

Relation between diagonal ear lobe crease and ischemic chronic heart disease and the factors of coronary risk.

Guţiu I, el Rifai C, Mallozi M.


The presence of a diagonal ear lobe crease (DELC) was studied in 350 non-selected patients admitted to the Clinic. The overall incidence of DELC was 45%, with a significant increase after the age of 50 years (24.8% before and 59.5% after fifty, p less than 0.001). The relationship between DELC and ischemic chronic heart disease (65% as against 23% in the patients without DELC, p less than 0.001) and with some coronary risk factors: arterial hypertension (40% in patients with DELC, 29% in those without, p less than 0.01), smoking (43%) as against 35% in those without DELC. The relationship with diabetes mellitus and obesity was not significant. A higher incidence of DELC was observed in males (66%) than in females (34%) (p less than 0.02). The lipid profile of patients with DELC presents significant cholesterolemia changes (251 +/- 71 mg as against 232 +/- 70 mg in those without DELC) and a less marked increase in lipemia and beta-lipoproteins. All risk factors presented a net increase in the subjects with bilateral DELC. It is concluded that DELC can be used for selecting asymptomatic subjects in the screening of a possible coronary heart disease.


Kardiologiia. 1984 Apr;24(4):43-6.

[Diagonal crease in the ear lobe in ischemic heart disease].

[Article in Russian]

Khalfen ESh, Alekaeva LD, Veselov VV, Alekseev IG.


Patients with coronary heart disease (CHD) show the presence of the diagonal fold of the earlobe both more frequently and in a more pronounced form. The more prominent the changes in the coronary vessels of the heart revealed by coronarography and the lower the tolerance of CHD patients toward exercise, the more frequent and marked the occurrence of the earlobe diagonal fold. The diagnostic use of this simple sign may contribute to an early detection of CHD patients, particularly under conditions of the mass screening of the population.


Acta Med Scand Suppl. 1982;668:60-3.

The diagonal ear-lobe crease, heredity and coronary heart disease.

Kaukola S.


J Am Geriatr Soc. 1980 Apr;28(4):184-7.

Diagonal ear lobe crease and coronary risk factors.

Shoenfeld Y, Mor R, Weinberger A, Avidor I, Pinkhas J.


The prevalence of ear lobe crease (ELC) was determined in 421 patients with myocardial infarction (MI) and in 421 controls. A higher prevalence (p less than 0.05) of ELC was found in MI patients (77 percent) in comparison to controls (40 percent), regardless of age. In addition, a higher prevalence was found in patients in whom MI was combined with diabetic retinopathy or hypertension, and in Ashkenazi Jews compared to non-Ashkenazi Jews. Ear lobe biopsies in 12 subjects revealed tears of the elastic fibers in all subjects with ELC, and prearteriole wall thickening in subjects with MI and/or ELC, but not in the 2 subjects with neither MI nor ELC. The early appearance of ELC may imply the existence of coronary heart disease with or without coronary risk factors.


Ulster Med J. 1980;49(2):171-2.

Diagonal ear-lobe crease: an independent risk factor in coronary heart disease?

Farrell RP, Gilchrist AM.


Acta Med Scand Suppl. 1978;619:1-49.

The diagonal ear-lobe crease, a physical sign associated with coronary heart disease.

Kaukola S.


Ann Intern Med. 1977 Aug;87(2):245.

Ear-lobe crease and coronary-artery heart disease.

Rhoads GG, Yano K.

PMID: 889207 [PubMed – indexed for MEDLINE]

Related citations


J Am Geriatr Soc. 1977 Apr;25(4):183-5.

Ear lobe creases and heart disease.

Doering C, Ruhsenberger C, Phillips DS.


In 50 patients with coronary heart disease (CHD) and 38 controls, comparative data on age, sex, serum cholesterol level, hypertension, obesity, diabetes, smoking habits, and ear-lobe creases were analyzed statistically. After adjustment for age differences, the factors which chiefly distinguished the two groups were the incidences of smoking, obesity, diabetes, and ear-lobe creases. Of these, the ear-lobe crease seemed to be correlated best with CHD, and may prove to be a useful diagnostic sign.


N Engl J Med. 1975 Aug 7;293(6):308-9.

Letter: Diagonal ear-lobe crease in coronary heart disease.

Christiansen JS, Mathiesen B, Andersen AR, Calberg H.



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