Introduction
An association between a diagonal ear lobe crease (DELC) and
cardiovascular disease was first suggested by Sanders T. Frank in 1973
in the New England Journal of Medicine(1). Since then
there have been numerous further studies that have investigated the
association of ‘Frank’s Sign’ with carotid disease, cerebral vascular
disease and diabetic retinopathy. Whilst almost all of the studies since
then have found a correlation between DELC and cardiovascular disease,
there is disagreement on whether this is an independent association or
whether both of these are related to increasing age or other potential
confounding cardiovascular risk factors (2).
The purpose of this meta-analysis is therefore to determine if there is
a significant association between the presence of a diagonal ear lobe
crease (Fig. 1) and coronary artery disease (CAD) independent of other
risk factors. Although there have been other reviews that have looked
into this (3), these have included autopsy studies or
clinically diagnosed CAD and none have specifically looked at studies
solely using coronary angiography which is the gold standard for
confirming CAD(4-6). At the same time, although this
is an aural sign, there have been no studies in any otology journals and
no reports in any otolaryngology literature. We believe this is the
first literature review and meta-analysis that solely looks at patients
with DELC undergoing angiography and the first article about this topic
in an otology publication.