MEDICINE DISEASE INDICATORS : Doctor Says Study Links Earlobe Crease, Heart Attacks
The earlobe has long served as a signpost.
Stage actors believe that an indentation on the lobe is a mark of acting ability. Some television performers, notably Carol Burnett, tug on it as a sign to friends and family. People pierce earlobes for earrings and punks puncture them as a mark of their rebellion.
Now, a Chicago physician has provided what he says is the strongest evidence yet that the shape of the earlobe can also be a reliable indicator of an individual’s risk of a heart attack.
The report promises to rekindle a debate on the proposed link that began about 20 years ago. But it is unlikely to settle the question, because the study’s methodology did not consider other, more accepted factors in heart disease such as heredity, diet and exercise.
Clinical pharmacologist William Elliott of the University of Chicago Medical Center will report Monday at an American Federation for Clinical Research meeting in Seattle that people with a diagonal crease across the earlobe--perhaps resulting from blood vessel changes similar to those that cause heart disease--are significantly more likely to die from heart disease than those without such a crease.
Elliott and others, especially cardiologist Edgar D. Lichstein of the Maimonides Medical Center in Brooklyn, have previously shown a suggestive link between the crease and heart disease, but critics have argued that the creases were coincidental. For the first time, however, Elliott has monitored people with creases for extended periods of time--a “prospective” approach that scientists find most convincing in determining a causal relationship. He found that those with an earlobe crease were eight times as likely to suffer heart disease as those without it.
The discovery “is a very interesting association . . . but I wouldn’t want to alarm my patients who have it (an earlobe crease),” said cardiologist Albert Oberman of the University of Alabama, chairman of the American Heart Assn.’s Committee on Epidemiology. “We can say that people with it should get their risk factors taken care of, but then everyone should anyway,” he said, referring to diet, exercise and other health measures.
In addition, the study did not take those or other risk factors into account in assessing the importance of the earlobe crease.
The possible link between earlobe creases and heart disease was first reported in 1973 by pulmonologist Saunders Frank, who is in private practice in Monterey Park. The crease is now sometimes called the “Frank sign.” Many subsequent reports have appeared, with mixed results, but most of them have been so-called retrospective studies.
Elliott, for example, reported in 1983 on 1,000 patients seen at the University of Chicago. “It was far from a perfect correlation,” he said. In that study, 74% of those with a crease had coronary artery disease, while 72% of those with coronary artery disease had a crease.
For the new study, Elliott selected 27 sets of patients between the ages of 54 and 72, each set containing four individuals matched by age, sex and race. In each set, one patient had an earlobe crease and existing coronary artery disease, one had only a crease, one had only coronary artery disease, and one had neither.
He followed their progress for more than eight years. At the end of that period, 28 of the 54 patients with earlobe creases had died of heart disease, compared to only nine of the 54 without the crease.
Elliott found that patients with both the crease and existing heart disease were three times as likely to die as those with established heart disease but no crease. Patients with an earlobe crease but no heart disease at the start of the study were eight times as likely to die as those who had neither a crease nor heart disease.
As unlikely as it seems, the relationship may have a sound physical basis. Lichstein has autopsied patients who died from heart disease and found that those with a crease in one ear had more obstruction in their coronary arteries than those with no crease, and those with creases in both ears had the greatest amount of obstruction. Arteries throughout the body, including the ear, should show similar obstruction, he said, and obstructions of those in the ear could cause a change in ear shape.
Pathologist Gary D. Cumberland of Sacred Heart Hospital in Pensacola, Fla., thinks the relationship might be caused by loss of elastin, a protein that allows blood vessels to expand and contract to permit changes in blood flow, such as during exercise. Loss of elastin has been linked to heart disease, and it could also cause the change in ear shape, he speculated.
But physicians are divided on the significance of the crease. Even Lichstein, who has done many of the crucial studies, views it as little more than a curiosity.
Frank, in contrast, said that “it has a very high predictive value for us. We see it used more and more in physical exams by other doctors. If it’s there, it is probably worth screening for other risk factors.”
Concluded Elliott: “We have altogether too many people dropping dead from heart disease without any prior warning. Maybe we’ll be able to help a few people who might not know they have bad cholesterol or bad blood pressure. Maybe if they see the crease, they’ll have them checked for other risk factors.”
