An earlobe crease may predict heart disease for people under 40 — here's what to look for

• An earlobe crease is a diagonal fold that is usually appears at a 45° angle.
• Some notable studies have found a correlation between earlobe creases and coronary artery disease.

If the part of your earlobe where earrings usually go has a distinctive crease, it might be an indication that you have coronary artery disease (CAD). The crease is usually at a 45° angle and extends diagonally backward.

The diagnoal earlobe crease is also called Frank's sign — named for the doctor who first observed this correlation in the 1970s.

While the crease isn't always a sign of CAD, experts recommend seeing a healthcare provider to check for cardiovascular disease if you have it.

Here's what experts know so far about Frank's sign and how it's related to cardiovascular health.

Does an earlobe crease mean you have CAD?

Many researchers have studied the predictive value of earlobe creases for CAD over the years and found the following results:

• In a large and often-cited study involving more than 500 autopsy cases, earlobe creases were found to predict CAD about 80% of the time for people below 40 years old.
• Another study also found that an earlobe crease is associated with the increased prevalence, extent, and severity of CAD.
• A more recent sudy observed 241 patients who were hospitalized with an acute stroke and found that 78.8% had a diagonal earlobe crease. The authors concluded that a diagonal earlobe crease is an independent predictor of ischemic stroke, a medical emergency that is linked to preexisting CAD.

However, a 2021 systemic review — the most recent work that attempted to summarize the diagnostic utility of the earlobe crease — reported that its accuracy to detect chronic coronary syndromes remains insufficient.

Overall, the predictive value of an earlobe crease isn't as strong as well-known risk factors such as smoking, diabetes type 2, and hypertension, says Dr. Jesus Lizarzaburu, a family medicine physician at TPMG Grafton Family Medicine.

Why would an earlobe crease indicate CAD?

There are plenty of theories about the relationship between diagonal earlobe creases and CAD, such as:

1. Lack of blood supply

Arteries normally supply your earlobes with the oxygenated blood they need to keep the tissue healthy. But if your arteries aren't working properly — a sign of CAD — then your earlobes may crease due to lack of blood supply.

2. Changes in DNA

In a 1984 letter to the health journal The Lancet, a professor from the Guy's Hospital Medical School in London suggested a potential hereditary link.

He theorized that changes in the DNA strand of a particular chromosome may be related to the diagonal ear lobe crease because they are both associated with atherosclerosis, the cause of CAD.

3. Loss of elastin

Elastin, a protein in the body responsible for the elasticity and strength of tissues, may also play a role.

The loss of elastin in the earlobes has been associated with the loss of elastin in the major arteries, says says Dr. William Elliott, chair of Biomedical Sciences at the Pacific Northwest University of Health Sciences. The physical crease may come as a result of the lack of blood supply.

4. Obesity

An earlobe crease may be a sign of obesity, which is an established risk factor for cardiovascular disorders.

5. Aging

A large study found that visible signs of aging, like an earlobe crease, are associated with the increased risk of CAD and heart attack, independent of chronological age.

Overall, the mechanism is not fully understood and more studies are needed to identify the root cause(s) of Frank's sign.

When to see a doctor

Those with an earlobe crease should see a healthcare provider to get checked for cardiovascular disease, says Dr. Arnon Blum, the author of the previously-cited study that linked earlobe creases with ischemic stroke, and vascular biology professor at the Bar-Ilan University Faculty of Medicine.

It's even more important to see a doctor if you experience other symptoms associated with CAD, says Dr. Alex McDonald, a family and sports medicine physician at Kaiser Permanente.

Other sympomts of CAD tend to get worse with exertion and resolve at rest. These include the following:

• Chest pain or pressure
• Vague pain in the shoulders or lower jaw
• Chest pain radiating to the left arm
• Leg pain or swelling
• Shortness of breath
• Fatigue

Given that heart disease is still the leading cause of death in the US, it's not unreasonable to see a healthcare provider to check your cardiovascular health even if you don't see an earlobe crease, Elliot says.

Generally, adults should get their blood pressure checked at least every two years. If you're over 40 years old or you have certain risk factors for heart disease — like smoking or diabetes — you may need check-ups more frequently.

Insider's takeaway

A diagonal earlobe crease may be an indicator of coronary artery disease, but the mechanism is still unknown.

If you have an earlobe crease, experts advise that you see a healthcare provider to check for heart disease.

But even if you don't, it's diligent to get your blood pressure checked at least every two years to stay on top of your cardiovascular health.