1. In a prospective study of over 550 adults, the presence of diagonal earlobe creases (DELC) was independently associated with risk of coronary artery disease (CAD)
2. Patients with bilateral DELCs demonstrated significantly higher prevalence of coronary artery stenosis compared to patients with unilateral DELCs
Evidence Rating Level: 2 (Good)
Study Rundown: CAD is characterized by the buildup of atherosclerotic plaque in coronary arteries and remains the leading cause of death worldwide. DELC have previously been associated with an increased risk of CAD. Although the pathophysiological mechanism of this association remains unclear, it is hypothesized that the genetic predisposition to the degeneration of elastin may account for both DELC and CAD. To date, there have been limited data on the relationship between bilateral DELC versus unilateral DELC and the diagnosis of CAD. The purpose of this prospective cohort study was to determine the relationship between unilateral versus bilateral DELC and CAD.
The trial prospectively followed over 550 consecutive adult patients who underwent coronary angiography for suspected coronary artery disease and examined for the presence of DELC. At the conclusion of the study, the presence of DELC were significantly associated with CAD independent of traditional cardiac risk factors. Additionally, the presence of bilateral DELC were associated a significantly increased risk for CAD compared to unilateral DELC. The results of this study support the use of the presence of DELC as a relevant physical examination finding to identify patients at increased risk of CAD. The study is strengthened by the use of coronary angiography to confirm the presence of CAD. However, the study had a relatively small sample size and had a patient population that is solely representative of the Chinese population, which limits the generalizability of this result to ethnically diverse populations.
Relevant Reading: Earlobe Crease Shapes and Cardiovascular Events
In-Depth [prospective cohort]: This study prospectively followed 558 participants (402 males and 156 females) who underwent coronary angiography for diagnosis of atherosclerosis at a single institution in China. Patients were examined for the presence of DELC as well as whether they were unilateral or bilateral. CAD was defined as the presences of >50% stenosis in at least one major vessel on coronary angiography. The severity of the atherosclerosis was defined by using the Gensini scoring system. At the conclusion of the study, the presence of DECLs were independently associated with a risk of CAD (OR: 4.86; 95% CI 3.09 to 7.64; p = 0.000). Additionally, patients with bilateral DELCs (OR: 5.69; 95% CI: 3.45 to 9.38; p = 0.000) demonstrated a significantly higher association with CAD compared to patients with unilateral DELCs (OR: 3.11; 95% CI: 1.60 to 6.07; p = 0.001). Overall, bilateral DELC were seen more frequently in men, the elderly, and those with severe coronary artery atherosclerosis.
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