Diagonal Ear Lobe Crease and Atherosclerosis: a Review of the Medical Literature and Dental Implications

Overview

Journal Med Oral Patol Oral Cir Bucal

Specialty Dentistry

Date 2011 Jul 12

PMID 21743392

Citations 8

Authors

Arthur H Friedlander

Jose Lopez-Lopez

Eugenio Velasco-Ortega

Affiliations

Soon will be listed here.

Abstract

In Spain a significant number of individuals die from atherosclerotic disease of the coronary and carotid arteries without having classic risk factors and prodomal symptoms. The diagonal ear lobe crease (DELC) has been characterized in the medical literature as a surrogate marker which can identify high risk patients having occult atherosclerosis. This topic however has not been examined in either the medical or dental literature emanating from Spain. The majority of clinical, angiography and postmortem reports support the premise that DELC is a valuable extravascular physical sign able to distinguish some patients at risk of succumbing to atherosclerosis of the coronary arteries. A minority of studies have however failed to support this hypothesis. More recently reports using B mode ultrasound have also linked DELC to atherosclerosis of the carotid artery and another report has related DELC to the presence of calcified carotid artery atheromas on panoramic radiographs. DELC is readily visible during head and neck cancer screening examinations. In conjunction with the patient's medical history, vital signs, and panoramic radiograph, the DELC may assist in atherosclerotic risk.

Citing Articles

Diagonal ear lobe crease: A premonitory diagnostic sign of impeding ischemic heart disease.

Bawaskar H, Bawaskar P, Bawaskar P J Family Med Prim Care. 2019; 7(6):1361-1367.

PMID: 30613525 PMC: 6293914. DOI: 10.4103/jfmpc.jfmpc_181_18.

Early diagnosis of atherosclerosis with panoramic radiographs: a review.

Borba D, Hipolito U, Pereira Y J Vasc Bras. 2018; 15(4):302-307.

PMID: 29930608 PMC: 5829729. DOI: 10.1590/1677-5449.002316.

Diagonal Earlobe Crease as a Significant Marker for Coronary Artery Disease: A Case-control Study.

Kamal R, Kausar K, Qavi A, Minto M, Ilyas F, Assad S Cureus. 2017; 9(2):e1013.

PMID: 28331775 PMC: 5338988. DOI: 10.7759/cureus.1013.

Relationship between diagonal earlobe creases and coronary artery disease as determined via angiography.

Wang Y, Mao L, Jia E, Li Z, Ding X, Ge P BMJ Open. 2016; 6(2):e008558.

PMID: 26868940 PMC: 4762085. DOI: 10.1136/bmjopen-2015-008558.

Ear lobe crease: a marker of coronary artery disease?.

Agouridis A, Elisaf M, Nair D, Mikhailidis D Arch Med Sci. 2016; 11(6):1145-55.

PMID: 26788075 PMC: 4697048. DOI: 10.5114/aoms.2015.56340.

References

PETRAKIS N, Koo L . Earlobe crease. Lancet. 1980; 1(8164):376. DOI: 10.1016/s0140-6736(80)90930-7. View

ELLIOTT W, Karrison T . Increased all-cause and cardiac morbidity and mortality associated with the diagonal earlobe crease: a prospective cohort study. Am J Med. 1991; 91(3):247-54. DOI: 10.1016/0002-9343(91)90123-f. View

BOUISSOU H, Pieraggi M, Julian M, Pendaries I, Seguier J, Salvador M . [Value of skin biopsy in coronary insufficiency]. Arch Mal Coeur Vaiss. 1973; 66(5):655-60. View

Bahcelioglu M, Isik A, Demirel B, Senol E, Aycan S . The diagonal ear-lobe crease. As sign of some diseases. Saudi Med J. 2005; 26(6):947-51. View

Kuon E, Pfahlbusch K, Lang E . [The diagonal ear lobe crease for evaluating coronary risk]. Z Kardiol. 1995; 84(7):512-9. View

Cheng T . More research needed on the association between diagonal earlobe crease and coronary artery disease. Arch Intern Med. 2000; 160(15):2396-7. DOI: 10.1001/archinte.160.15.2396. View

Friedlander A, Cohen S . Panoramic radiographic atheromas portend adverse vascular events. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 103(6):830-5. DOI: 10.1016/j.tripleo.2006.07.016. View

Gutiu I, Galetescu E, Gutiu L, Raducu L . Diagonal earlobe crease: a coronary risk factor, a genetic marker of coronary heart disease, or a mere wrinkle. Ancient Greco-Roman evidence. Rom J Intern Med. 1996; 34(3-4):271-8. View

Kristensen B . Ear-lobe crease and vascular complications in essential hypertension. Lancet. 1980; 1(8162):265. DOI: 10.1016/s0140-6736(80)90761-8. View

10.

Toyosaki N, Tsuchiya M, Hashimoto T, Kawasaki K, Shiina A, Toyooka T . Earlobe crease and coronary heart disease in Japanese. Heart Vessels. 1986; 2(3):161-5. DOI: 10.1007/BF02128142. View

11.

Mehta J, HAMBY R . Letter: Diagonal ear-lobe crease as a coronary risk factor. N Engl J Med. 1974; 291(5):260. DOI: 10.1056/NEJM197408012910519. View

12.

Lichstein E, Chadda K, Naik D, Gupta P . Diagonal ear-lobe crease: prevalence and implications as a coronary risk factor. N Engl J Med. 1974; 290(11):615-6. DOI: 10.1056/NEJM197403142901109. View

13.

Kenny D, Gilligan D . Ear lobe crease and coronary artery disease in patients undergoing coronary arteriography. Cardiology. 1989; 76(4):293-8. DOI: 10.1159/000174506. View

14.

Rohani M, Jogestrand T, Ekberg M, van der Linden J, Kallner G, Jussila R . Interrelation between the extent of atherosclerosis in the thoracic aorta, carotid intima-media thickness and the extent of coronary artery disease. Atherosclerosis. 2005; 179(2):311-6. DOI: 10.1016/j.atherosclerosis.2004.10.012. View

15.

Doering C, Ruhsenberger C, Phillips D . Ear lobe creases and heart disease. J Am Geriatr Soc. 1977; 25(4):183-5. DOI: 10.1111/j.1532-5415.1977.tb00290.x. View

16.

Brady P, Zive M, Goldberg R, Gore J, Dalen J . A new wrinkle to the earlobe crease. Arch Intern Med. 1987; 147(1):65-6. View

17.

Merlob P, Amir J, REISNER S . Diagonal earlobe crease in newborn infants and in children. Clin Pediatr (Phila). 1981; 20(11):739-40. View

18.

Christiansen J, Mathiesen B, Andersen A, Calberg H . Letter: Diagonal ear-lobe crease in coronary heart disease. N Engl J Med. 1975; 293(6):308-9. DOI: 10.1056/NEJM197508072930626. View

19.

Marzolo M, Verlato F, Zotta L, Guadagnin M, Borgese L, Cravatari M . Occult atherosclerosis and physical vascular examination: a simple strategy to avoid inadequate cardiovascular prevention and under-use of diagnostic vascular guidelines in outpatients. A multicenter study by Angiology Care Units in North-Eastern.... Int Angiol. 2008; 27(5):426-32. View

20.

Raman R, Rani P, Kulothungan V, Sharma T . 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). BMC Ophthalmol. 2009; 9:11. PMC: 2762956. DOI: 10.1186/1471-2415-9-11. View