The Heart-Head Connection: Heart Disease and…Ears?

by DailyHealthPost Editorial

ear crease heart disease

the-heart-head-connection-heart-disease-an-earsWhatever the size, shape, thickness, or color, most people have smooth earlobes.

But have you ever met someone that has a crease in their earlobe—a line that seems to split it in two? That’s known as “Frank’s Sign”.

Not surprisingly, it’s named after the man who first recognized it as something other than a simple skin wrinkle.


Sanford Frank wrote a letter to the New England Journal of Medicine in 1973. In it, he described his research into the correlation between an ear crease and heart disease (1).

Ear Crease And Heart Disease

Many studies have since been performed and the great majority have supported Frank’s research (2). It hasn’t been definitively determined why heart disease may manifest in a fold in the earlobe.

Theories include:

  • Lack of blood flow to the ears will cause the lobe to wrinkle. If the blood can’t get through to the ears, there’s a blockage somewhere.
  • Elastin and collagen fibers weaken in the ears, indicating a  similar weakening of coronary arteries (3).
  • The coronary arteries end at the ears; vascular disease there means vascular disease further up the line (4, 5).

Other Theories

A Japanese study found that diagonal earlobe crease (DELC) may be caused by shortened cell telomeres associated with metabolic syndrome. It concluded that  DELC “might be a useful indirect marker of high-risk patients.” (6).

Telomeres are areas at the end of each strand of DNA that protect cells from damage. The longer the telomere, the better.

A Noticeable Symptom

Interestingly, a noticeable crease in the earlobe is often an indicator of cardiovascular disease in the absence of any other symptoms.


A study published in 2014 tells of a man with hypertension who went to an outpatient clinic. The physician saw Frank’s sign on both earlobes and suggested further testing, although the man displayed no symptoms of heart problems. After testing, it was found that the left main coronary artery was 80% blocked and the right was 90% blocked. “The patient underwent 3-vessel coronary artery bypass graft surgery and has since done well.”

Other Factors

Oddly, prevalence of DELC may be partly cultural/regional.

Another Japanese study found an unarguably strong correlation between ear crease and heart disease. However, the prevalence among the 1000 people involved in the study was less than expected.

“It is concluded that: (1) the prevalence of EC [ear crease] in Japanese adults is very low compared with the results of previous studies in Europe and America; (2) the prevalence of EC tends to increase with advancing age but is unrelated to other risk factors for CHD [coronary heart disease]; (3) a statistically significant association between EC and CHD is seen from multivariate analysis using both clinical and angiographic criteria in the diagnosis of CHD.” (7)

Can Ear Lobes Give Other Signs?

DELC may be a clear tell-tale sign of heart disease, but not when mixed with other conditions. One study aimed to discover if DELC would be a credible identifier of vascular disease and retinopathy in diabetics—it wasn’t (8).

In response, a grading system has been developed for DELC that indicates the severity of current cardiovascular risk:

  • Unilateral incomplete – least severe
  • Unilateral complete – moderate
  • Bilateral complete – most severe (9)

Like a canary in a coal mine, should you notice a permanent crease in someone’s ear, don’t ignore it. Early intervention in the case of heart disease can be a life saver.