Update 7/27/20. What if there was a way to look at someone and tell if they had heart disease? What if this sign was so subtle that you've been seeing it every day on other people – or on yourself each time you look in the mirror? Would you want to know about it? I believe knowledge is power and so I want you to know about “The Earlobe Crease.” For decades, some researchers have believed that a diagonal line in the earlobe is a visual sign of heart disease. Controversial? Yes. In this review, I will not only share with you some of the research on this mystery, but I'll also, first time, reveal the results of my own decades-long experiment on myself. My hope is to not only educate you, about something interesting but more than that, hopefully, spark a conversation with your doctor so that you can get more personalized information about whether or not the earlobe crease is relevant to you. See the bergamot review for the cholesterol-lowering evidence on that supplement.
What Is The Earlobe Crease?
The earlobe crease (ELC) refers to a diagonal line or crease (basically, a wrinkle) in the skin of the earlobe. You can see it on people when you look at their ears. In some people, there may be one or several creases per earlobe. The crease may appear as either a fine line or penetrate deep into the skin, altering the direction of the earlobe.
I have seen some creases so deep that the earlobes of people are actually bent, pointing laterally, away from the head! The crease often starts
on one ear and later progresses to both ears. When both ears have creases, it said to be bilateral. Men tend to have more ELCs than women and the crease is rare in children.
Because the crease often occurs at a diagonal angle, it is also called “DELC” (diagonal earlobe crease).
The first formal report of the earlobe crease was made in 1973 by Dr. Sanders Frank. Because of his observation, it is sometimes called “Frank's Sign”.
Earlobe Crease / Heart Disease Theories
Over the years, there have been several theories put forth to explain what the ear crease (ELC) represents. Here is just a few of them:
1. The ELC is a marker for heart disease.
2. The ELC reflects blockages in blood vessels.
3. The ELC is formed over time because of how we sleep.
4. The ELC is the result of aging-related changes in the earlobe and is not related to heart disease.
5. The ELC is a sign of premature aging.
Earlobe Crease In History
While not officially “discovered” until the 20th century, there is evidence that the earlobe crease was known to our ancestors. For example, there is a picture of Robert E Lee (of Civil War fame) revealing an ear lobe crease. Going back even further, earlobes of those depicted in some ancient Greek statutes also contain earlobe creases.
If the ELC really is a marker for heart disease, this fact lends even more evidence that the disorder has been an issue for thousands of years.
Attribution: By English: Following Hadrian (Flickr) [CC BY-SA 2.0 (http://creativecommons.org/licenses/by-sa/2.0)], via Wikimedia Commons
Earlobe Crease Research
As part of this review, I tried to find relative research on the association between the earlobe crease and heart disease. To be fair, I also looked for studies showing no relationship. To locate studies, I searched the National Library of Medicine (Pubmed.gov) for the following words:
- Earlobe crease
- Ear lobe crease
- Diagonal Earlobe Crease
- Diagonal Ear Lobe Crease
I purposely picked these words in the hope of casting the widest net. In other words, I wanted to find as many studies as I could. One drawback to this review is that it's limited to studies published in English.
Because many of the studies are complex, I will provide a short summary of each investigation and its basic conclusions. I've linked to the studies also to help you with your own research.
Earlobe Heart Disease Studies
In a small study from the 1970s researchers noted that of all the heart disease risk factors they looked at, “the ear–lobe crease seemed to be correlated best with CHD (heart disease)”
Studies from the 1980s
Researchers in 1983 looked at 1,000 people and noted “a strong correlation between coronary artery disease and the ear lobe crease.”
A few years later, other researchers observed that 65% of those with heart disease had ear creases (only 23% of those without creases had the disease). Other investigators noted that the ELC as well as having hair in the ear canal was a better predictor of heart disease than other factors, when
It's well known that negative stress is related to heart disease. Researchers in 1989 noted that of the 143 people in their 50 s, the 60s and 70s's they looked at, all had higher levels of anxiety than those who did not have earlobe creases.
Studies from the 1990s
In 1990, researchers looked at 100 autopsies of men (50-79 yrs of age) who did not die from heart disease. They compared the depth and length of ear creases to cholesterol levels and the degree of plaque in the arteries. They noted that the deeper and longer the ear lobe crease was, the greater the plaque was in the coronary arteries. They also found that these same people tended to have higher total cholesterol levels too. To be fair, not all studies find higher cholesterol levels in people with ear creases.
Other researchers looking at over 1400 people observed the earlobe crease was present in 28% of those who had no heart disease symptoms and 65% in those who had heart disease. In other words, the crease was present over twice as much in those who had heart disease.
Studies from the 2000s
In 2004, investigators looking at 415 people noted that having the ELC on both ears was “significantly associated with heart disease and coronary risk factors
A couple of years later, researchers looking at the autopsy reports of 520 people, concluded the presence of the ELC is “strongly correlated with CAD (heart disease) in both men and women. In addition, in people under 40 years old, the earlobe crease predicted – by about 80% – the presence of heart disease. It was concluded that the earlobe crease “could be especially useful in screening for premature heart disease in younger individuals.”
Is the ear lobe crease connected to changes inside the carotid artery? To find out, investigators compared older 65 men with the ELC to 65 other older men who did not have creases in their earlobes. This was the first study to show a significant connection between ELCs and the thickening of walls of the carotid arteries. These results were confirmed by Japanese researchers who also found the ELC was was associated with
In another study, Korean researchers looked at 573 people aged 20-80 who did not have diabetes or high blood pressure. They noted the earlobe crease was significantly associated with greater artery stiffness.
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In a 2012 paper titled Relation of diagonal ear lobe crease to the presence, extent, and severity of coronary artery disease determined by coronary computed tomography angiography, researchers looked at the blood vessels of 430 people. They concluded that the presence of a diagonal ear lobe crease was “independently and significantly associated with increased prevalence, extent, and severity of CAD” (heart disease).
Investigators in China compared 50 people with heart disease to 50 people who did not. These researchers noted that “the presence of an ear lobe crease (ELC) was significantly associated with coronary heart disease.” Interestingly, they also noted significantly more hair growth in the ears – especially the right ear – in those who had heart disease. This finding ear hair was also noted in the 1989 Indian study listed above.
A meta-analysis is a “study of other studies.” Basically, researchers look at the past research and see if they can find a consensus or similar agreement in what all the studies found. One such analysis included over 31,000 people. It was concluded that the risk of heart disease was more than 3 times higher in those who had an ear crease compared to those who didn't.
Other researchers noted that the presence of a diagonal earlobe crease in 430 people “was the only independent predictor” of having 50% of your coronary arteries blocked by plaque.
Chinese researchers, looking at 449 people, observed a diagonal crease in the earlobe was found in 46% of those without heart disease and 75% in those who did have it. Those with the crease had more blocked blood vessels and more blocked coronary blood vessels than those who did not have a crease.
In another investigation, researchers looked at whether or not the ELC was linked to peripheral artery disease (PAD) in 253 people.
Peripheral artery disease (PAD) refers to blocked blood vessels in the arms and legs. Sometimes, people with PAD experience burning or camping in the legs when they walk. PAD increases the risk of heart attack and strokes.
Those who had the crease in their earlobes had “increased prevalence, extent, and severity of PAD in patients without overt atherosclerotic vascular disease.” In other words, the earlobe crease was associated with a worsening of heart disease even when the people were not yet showing any symptoms. This study corroborates a 2010 investigation of 60 people that also noted a relationship between ear creases and PAD.
A large study from Denmark involved over 10,000 people who were followed from 1976 to 2011. Basically, the researchers noted that looking old for your age was associated with worse heart health during the lifespan.
The aging factors linked to heart disease in this study were the earlobe crease, male pattern baldness, and xanthelasmata (fat and cholesterol deposits around the eyes). This infers that the earlobe crease might reflect sub-clincial heart disease. In other words, heart disease before you start having symptoms. The more looking old for your age signs a person had, the greater the risk of heart disease and heart attack. Fortunately, having having grey hair was connected to heart disease.
Another study, involving 956 people, who were undergoing a heart procedure, noted the diagonal earlobe crease (DELC) was associated with heart disease and was most significant in those who had more than 4 heart disease risk factors. These researchers also stated having earlobe creases on both ears was associated with higher CRP levels (an inflammation marker), more heart disease, and higher chance of having problems after heart surgery.
What about stroke? To see if the ELC raised the risk of stroke, researchers looked at involving 1,000 people and noted the ELC was associated with heart attacks and strokes. Interestingly, this study did not show the depth of the earlobe crease mattered. In other words, simply having a crease was more important than how deep the crease was.
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Another investigation looked at 65 healthy people who had the ELC and compared them to 65 healthy people who did not have it. All the people were in their late 50s. The researchers noted significantly greater fat in the heart in those who had the earlobe crease. They also noted a greater degree of thickening of the carotid arteries in those who had the ELC compared to those who did not have it.
Another study – involving 4635 people
Another 2016 study, involving 4,635 people, noted a significant relationship between the earlobe crease and high blood pressure as well as having a history of heart disease.
Other investigators published a study that looked for the presence of the ELC in 400 people. They noted that having creases on both earlobes was associated with worse blood vessel functioning. Interestingly having only 1 ear lobe crease was not associated with poor blood vessel functioning.
In a separate study, researchers looked at 223 people with heart disease risk factors. Those people were divided into 2 groups – whether they had an earlobe crease or those who didn't have it. They concluded that those having the crease had more oxidative stress and cellular inflammation than those who did not have the crease. Those with the ELC had more high blood pressure, more diabetes and had higher CPR levels than those who did not have it. Those with the crease also tended to be male too.
Ear Lobe Crease and Diabetes
Metabolic syndrome or “pre-diabetes” is getting worse in industrialized nations like the US. Is there a connection to the crease? Korean researchers wanted to know and so they looked at 3,835 Koreans (age 20-79) to see if there was a relationship. They noted that the odds of having pre-diabetes significantly increased (by about 11%) if the ELC was present. That said, the use of earlobe creases as a diagnostic tool was said to be “limited.”
Basically, it sounds like they were saying, take a look at the earlobes, but just because someone has an ELC may not mean they have metabolic syndrome or diabetes. Fortunately, there are better tests for metabolic syndrome such as hemoglobin AIC and blood sugar tests. For more on diabetes see this.
Their conclusions are similar to a 2009 study of diabetics in India. Those researchers noted that while almost 60% of the 1,414 diabetics over age 40 who were studied had creases in ear lobes, they did not feel it was a good screening tool for diabetic retinopathy.
Do Earlobe Creases Mean Shorter Telomeres?
Telomeres are pieces of DNA that are thought to be related to the aging process. They are often described as being like the plastic caps at the ends of shoelaces. It's thought that shorter telomeres may reflect greater aging and susceptibility to disease.
To see if telomere shortening was related to having an earlobe crease, Japanese researchers recruited 34 men under age 70 who either had creases in both ears or who didn't. They found that men with creases in both ear lobe had shorter telomeres than those who did not have creases.
Conflicting Earlobe Crease Studies
To say that the earlobe crease is controversial is an understatement. So, to be fair, there are studies showing that the ELC was not associated with heart disease.
In a 1984 study titled Lack of association of diagonal earlobe crease with other cardiovascular risk factors, researchers looked at 686 people and found no association between ear lobe crease and heart disease.
Researchers in 1986 looked at 100 people to try to find a connection between ELCs and heart disease. The paper they published, titled, The ear lobe crease sign and coronary artery disease in aortic stenosis, failed to find a link, leading the researchers to conclude that “that this physical sign (ELC) is of little practical value in this clinical setting.”
Researchers conducting a study published in 1989 titled Ear lobe crease and coronary artery disease in patients undergoing coronary arteriography concluded that the ELC was not related to heart disease. This study involved 125 people who were having a heart procedure (coronary angiography) performed. While the ELC was observed in 65 of the 125 patients (52%), it was not associated with age, high blood pressure, gender, smoking history, family heart health, BMI or previous heart attack.
In a 1992 study titled The diagonal ear lobe crease (Frank's sign) is not associated with coronary artery disease or retinopathy in type 2 diabetes: the Fremantle Diabetes Study, researchers looked at 1,082 people in Australia. Almost 80% of these people had type II diabetes (a condition that raises the risk of heart disease).
While the earlobe crease was detected in 55% of the people, after adjusting for age, gender, and other variables, the ELC was not found to be an independent risk factor in either heart disease or diabetic retinopathy (diabetes-related eye damage).
A 1995 study titled The diagonal ear lobe crease for evaluating coronary risk noted that the ELC was not associated with heart disease but was associated with age and being overweight. This study involved 670 people.
A study from 1995 titled Earlobe crease in women: evaluation of reproductive factors, alcohol use, and Quetelet index and relation to atherosclerotic disease, found no association between alcohol use and ELC in 625 causation women.
Heart disease raises the risk of dementia. S0, researchers tried to see if crease in the earlobes could be a sign of mental decline. They looked at 629 people over the age of 40. Of these people, 39% (246) had the ELC. These researchers saw no association between the presence of an ear lobe crease and mental decline. Rather, they stated crease in the earlobes was “mainly related to age.”
In another investigation, Japanese researchers, looking at 274 dialysis patients found no association with the ELC and said it was just a marker of advanced aged.
Summary Of Research
Here is a quick rundown of the studies summarized above. Remember, in the table, “ELC” refers to earlobe crease.
|Study Title||Number Of People In Study||Study Results|
|Relation of the Bilateral Earlobe Crease to Endothelial Dysfunction.||400 people||Having 2 ELC is associated with poor blood vessel functioning|
|Diagonal earlobe crease associated with increased epicardial adipose tissue and carotid intima media thickness in subjects free of clinical cardiovascular disease||65 people||ELC associated with more fat in the heart and carotid artery thickening|
|Did Dumbo suffer a heart attack? independent association between earlobe crease and cardiovascular disease,||4635 people||ELC associated with high blood pressure and history of heart disease|
|The association of circulating inflammatory and oxidative stress biomarker levels with diagonal earlobe crease in patients with atherosclerotic diseases||223 people||ELC associated with greater oxidative stress and cellular inflammation|
|Earlobe crease shapes and cardiovascular events||1,000 people||ELC was associated with heart attacks and strokes|
|The Combined Effect of Ear Lobe Crease and Conventional Risk Factor in the Diagnosis of Angiographically Diagnosed Coronary Artery Disease and the Short-Term Prognosis in Patients Who Underwent Coronary Stents||956 people||ELC associated with heart disease|
|Visible Age-Related Signs and Risk of Ischemic Heart Disease in the General Population||10,885 people||looking old for your age - including ELC -linked to heart disease|
|Earlobe crease may provide predictive information on asymptomatic peripheral arterial disease in patients clinically free of atherosclerotic vascular disease||253 people||ELC linked to peripheral artery disease|
|Diagonal earlobe crease and coronary artery disease in a Chinese population||449 people||ELC associated with more heart disease and blocked blood vessels|
|Incremental value of diagonal earlobe crease to the Diamond-Forrester classification in estimating the probability of significant coronary artery disease determined by computed tomographic angiography||430 people||ELC associated with having significantly blocked blood vessels|
|Ear lobe crease as a marker of coronary artery disease: a meta-analysis||Meta-analysis of over 31,000 people||ELC associated with 3x greater risk of heart disease|
|Association Between Earlobe Crease and the Metabolic Syndrome in a Cross-sectional Study||3,835 people||ELC associated with pre-diabetes although probably not a good screening tool|
|Predictive Value of Auricular Diagnosis on Coronary Heart Disease.||100 people||ELC associated with heart disease|
|Relation of diagonal ear lobe crease to the presence, extent, and severity of coronary artery disease determined by coronary computed tomography angiography,||430 people||ELC associated with the prevalence, severity of heart disease|
|Diagonal ear lobe crease in diabetic south Indian population: is it associated with Diabetic Retinopathy?. Sankara Nethralaya Diabetic Retinopathy Epidemiology And Molecular-genetics Study (SN-DREAMS, Report no. 3)||1,414 people||ELC not a good screening tool for diabetic retinopathy|
|Diagonal earlobe crease are associated with shorter telomere in male Japanese patients with metabolic syndrome||34 people||ELC associated with shorter telomeres|
|Relationship Between Earlobe Crease and Brachial-ankle Pulse Wave Velocity in Non-hypertensive, Non-diabetic Adults in Korea||573 people||ELC associated with stiffer arteries|
|Diagonal Ear-Lobe Crease is Correlated With Atherosclerotic Changes in Carotid Arteries||212 people||ELC associated with thicker carotid artery walls|
|Diagonal ear-lobe crease is associated with carotid intima-media thickness in subjects free of clinical cardiovascular disease||130 people||ELC associated with thicker carotid artery walls|
|The earlobe crease, coronary artery disease, and sudden cardiac death: an autopsy study of 520 individuals||500 autopsies||ELC strongly associated with heart disease especially in people under 40|
|Bilateral diagonal earlobe crease and coronary artery disease: a significant association||414 people||ELC associated with heart disease|
|The diagonal ear lobe crease for evaluating coronary risk||670 people||ELC not associated with heart disease,. It was associated with being overweight|
|Earlobe crease in women: evaluation of reproductive factors, alcohol use, and Quetelet index and relation to atherosclerotic disease||625 people||ELC not associated with alcohol use|
|Diagonal earlobe crease as a marker of the presence and extent of coronary atherosclerosis||1,424 people||ELC associated with heart disease|
|The diagonal ear lobe crease (Frank's sign) is not associated with coronary artery disease or retinopathy in type 2 diabetes: the Fremantle Diabetes Study||1,082 people||ELC not associated with heart disease or diabetic retinopathy|
|Earlobe crease and atherosclerosis. An autopsy study||100 autopsies||ELCs that were deeper/longer associated with worse heart disease|
|Diagonal ear-lobe crease: possible significance as cardio-vascular risk factor and its relationship to ear-acupuncture.||143 people||People with ELC had greater levels of anxiety|
|Ear lobe crease and coronary artery disease in patients undergoing coronary arteriography||125 people||ELC not associated with heart disease|
|Ear-lobe crease and ear-canal hair as predictors of coronary artery disease in Indian population||215 people||ELC associated with heart disease and higher cholesterol levels.|
|Relation between diagonal ear lobe crease and ischemic chronic heart disease and the factors of coronary risk||350 people||More ELCs in people with heart disease than without heart disease|
|The ear lobe crease sign and coronary artery disease in aortic stenosis||100 people||ELC not associated with heart disease|
|Lack of association of diagonal earlobe crease with other cardiovascular risk factors||686 people||ELC not associated with heart disease|
|Ear lobe crease and coronary artery disease. 1,000 patients and review of the literature||1,000 people||ELCs associated with heart disease|
|Ear lobe creases and heart disease||50 people||ELC was a better predictor of heart disease than other risk factors|
Gender And Ethnicity And Earlobe Creases
Do men get the ELC more than women – or vice versa? As is pointed out by this 2016 study, it appears that generally, men have more earlobe creases than women do. The review article also points out that Caucasians tend to have the most ELCs while Asians tend to have the least.
Does Time Of Day Matter?
If you are checking your own earlobes it may be best to check after you have been awake for at least an hour or so. Because many of us may sleep on our sides, it's possible that this might influence the appearance of the crease.
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Could This Just Be Skin Aging?
As we get older, our skin ages – and that includes the skin of our ears too. Being outside without protection accelerates photo-aging (sun-induced aging). As far back as 1983, researchers noted people with earlobe creases had greater elastin breakdown in their ears than did those who did not have creases.
This hints that maybe the earlobe crease may not be a sign of heart disease but rather generalized aging skin. In other words, as we get older, our skin ages (ears too) and so too does the trend to develop heart disease. Reinforcing this idea is the finding that children rarely get creases in their ears.
To play devil's advocate, if the ELC is the result of changes in elastin or collagen which make up the earlobes, is it possible this change parallels changes in the elastin or collagen of blood vessels too? To say it another way, could the earlobe crease be a viable sign of artery stiffness?
This 2009 study of 573 people in Korea (20-80 years of age) did find that the earlobe crease was significantly associated with artery stiffness. This 2013 study involving 75 people also found more artery stiffness in those who had a crease in the earlobe.
In a study from 1980, researchers noted that some of the people with the ELC had ” tears of the elastic fibers” of their ears. Those researchers speculated that the tears may be due to reduced blood flow to the earlobe, leading to the development of creases.
Why Don't Doctors Believe This?
I've spoken to several doctors over the years about the earlobe crease – including cardiologists. The response most gives me is that they don't believe the earlobe crease is a marker for heart disease. Looking at the evidence, I have to wonder why it would not even be considered? Even if it is a medical anomaly, it's something people can see for themselves, and because of that, I'd hope doctors might use this as an opportunity to have a conversation with patients about the importance of staying healthy.
If we accept that blockage of the small blood vessels in the penis are related to erectile dysfunction (ED) and that ED can be an early sign of heart disease, is it possible the same thing might be happening in the small blood vessels of the earlobes?
I first heard of the earlobe crease when I was 13 years old (yes, really!), while watching an episode of the old Merv Griffin talk show. Back then, Merv would periodically bring on a long-haired research scientist named Dirk Pearson, who used to talk about all sorts of far-out stuff that was appealing to a geeky kid like me. One day, the topic was the earlobe crease. Dirk, later went on to write a very popular book called Life Extension.
That day began my experiment. Over the next 40 years, I periodically checked my ear lobes.
- 20s: nothing
- 30s: nothing
- 40: nothing
At about 45, I started to see a little line in my earlobe. Now, in my 50′, both earlobes each have 2 thin, fine lines. What does this mean?
To the real scientists reading this, I know – I'm just one person. I know that an “n of 1” doesn't matter much. At best, I'm a case study. At worst, I'm someone who fell down the earlobe crease rabbit hole a long time ago.
Do my creases mean I have heart disease? Well, I'm pretty sure I do have some degree – and you probably do too. That's because we know blood vessel damage can start in the teens. The question here is whether creases in the earlobes can be used as visible signs of that damage?
Is The Earlobe Crease Real?
Personally, I think there's something to the earlobe crease and I say that because most of the studies say there is a connection. Is it perfect? I don't think so because I'm quite sure people with perfectly smooth earlobes have had heart attacks. Obviously, correlation does not mean cause and effect and it might just be that getting older and having an earlobe crease is completely unrelated.
For the person reading this who just ran into the bathroom to check their earlobes, instead of freaking out if you have a crease, why not use this as an opportunity to see your doctor and bring this up. Say something like “Hey doc, it's been a while since I was here and I want to know about my risk of a heart attack or stroke? I'm aware of that weird earlobe crease but I want to get a better idea. What do you suggest?” If you say it like that, I'm confident most doctors will have an honest conversation with you and run some medical tests.
Even if the earlobe crease is ultimately proven to be a fluke, the important thing is that by going to your doctor, you will have more information about your heart disease risk – and if the answers you get are less than stellar, you can use that knowledge to take action to improve. And THAT is what is most important.