Diagonal Earlobe Crease as a Significant Marker for Coronary Artery Disease: A Case-control Study.
OBJECTIVE
To investigate the association between diagonal earlobe crease (DELC) and coronary artery disease (CAD). Limited data exists in South Asia and no prior studies have been performed in Pakistan to assess this relationship.


METHODS
In this case-control study, 200 participants from December 2015 to March 2016 at Shifa International Hospital, Islamabad, Pakistan were enrolled. Consecutive non-probability sampling was used to recruit patients. Cases were enrolled from cardiac care unit (CCU) of the hospital with angiography-proven CAD. Controls were selected from surgical, medical and neurology units of the hospital if they had no previously established evidence or symptoms of CAD. Patients were evaluated in terms of age and any history of hypertension, diabetes and/or smoking. Cases and controls were examined separately by two investigators for the unilateral or bilateral presence of DELC of the lobular portion of either auricle. Patients with ear piercings were excluded from the study. The data was analyzed in statistical product and service solutions (SPSS) (IBM, Delaware, Chicago), and an online statistical software.


RESULTS
Out of the 200 patients, 126 (63%) were males and 74 (37%) were females. In the 100 cases, 76 had DELC and 24 had no crease whereas, among the 100 controls, 36 had DELC and 64 had no DELC (p <0.001, OR = 5.63, CI = 2.91-10.93). The prevalence of diseases such as hypertension, diabetes, smoking among the cases and controls were 66%, 53%, 27% and 27%, 18%, 25% respectively. The effect of hypertension and diabetes on the presence of DELC was statistically significant (p <0.05) but the impact of smoking on DELC presence was insignificant (p >0.05).


CONCLUSIONS
There is a significant association between DELC and CAD. This is the first case-control study from South Asia disclosing this important correlation. Our study also reports a high frequency of DELC in patients suffering from hypertension and diabetes mellitus. No association between smoking and DELC was found.
Department of Medicine, Shifa College of Medicine, Islamabad, Pakistan.
Rida
R
Kamal
Department of Medicine, Shifa College of Medicine, Islamabad, Pakistan.
Komal
K
Kausar
Department of Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, NY, USA.
Ahmed H
AH
Qavi
Department of Medicine, Eastbourne District General Hospital, UK.
Moeed H
MH
Minto
Department of Medicine, University of Texas at Austin, Dell Medical School, Austin, TX, USA.
Fariha
F
Ilyas
Department of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
Salman
S
Assad
Department of Cardiology, Shifa College of Medicine, Islamabad, Pakistan.
Saeed U
SU
Shah
cad; coronary artery disease; delc; diabetes; diagonal earlobe crease; hypertension; smoking