title: Diagonal earlobe creases and prognosis in patients with suspected coronary artery disease.
abstract: OBJECTIVE
  To determine whether high-risk patients with unilateral, bilateral, or no earlobe creases (ELC) have different prognoses for common sequelae of coronary heart disease.
  
  
  METHODS
  Two hundred sixty-four consecutive patients from a university-based coronary care unit or catheterization laboratory were blindly followed up for 10 years, using questionnaires, medical records, and death certificates. The primary outcome measure was time to cardiac event; namely, coronary artery bypass graft (CABG), myocardial infarction (MI), or cardiac death. Analyses included log-rank tests and Cox proportional hazards regression modelling.
  
  
  RESULTS
  The number of creased ears was significantly associated, in a graded fashion, with 10-year cardiac event free survival: 43.5% +/- 5.7%, 33.0% +/- 6.7%, or 17.5% +/- 4.6% (mean +/- standard error for 0, 1 or 2 ELC, respectively; P = 0.003). After adjustment for 10 known cardiac risk factors, including age and left ventricular ejection fraction, the relative risk for a cardiac event for a unilateral ELC, relative to 0 ELC, was 1.33 (95% confidence interval [CI] 1.10 to 1.61, P = 0.02), and for bilateral ELC, it was 1.77 (95% CI 1.21 to 2.59, P = 0.003).
  
  
  CONCLUSIONS
  Ear lobe creases are associated, in a graded fashion, with higher rates of cardiac events in patients admitted to hospital with suspected coronary disease. In such patients, ELC may help to identify those at higher risk for sequelae for coronary disease.
authors.affiliation: Department of Preventive Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA.
authors.forename: W J
authors.initials: WJ
authors.lastname: Elliott
authors.forename: L H
authors.initials: LH
authors.lastname: Powell
mesh_terms: D003327:Coronary Disease / Q000175:diagnosis*; D018572:Disease-Free Survival; D004431:Ear, External / Q000002:abnormalities*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors