Value of Transverse Groove on the Earlobe and Hair Growth on the Ear to Predict the Risk for Coronary Artery Disease and Its Severity among Iranian Population, in Tehran City
DOI:
https://doi.org/10.31661/gmj.v9i.1443Keywords:
Groove; Earlobe; Hair Growth; Coronary Artery Disease; Iranian PopulationAbstract
Background: The use of phenotypic parameters along with other noninvasive diagnostic modality can lead to early diagnosis of coronary artery disease (CAD) and prevent its life-threatening outcome. Recently, the application of head and face components for assessing the risk for CAD much attention has been paid. The present study aimed to assess the relationship between ear characteristics (transverse groove on the earlobe and hair growth on the ear) and the risk for CAD and its severity among Iranian patients. Materials and Methods: In this cross-sectional study, the study population consisted of 105 consecutive patients with suspected CAD undergoing coronary angiography. The severity of CAD was determined by the number of disease vessels as well as the presence of left main lesions assessed by coronary angiography. All patients were examined to evaluate the appearance of ear regarding the presence of transverse groove on the earlobe and hair growth on the ear. Results: Comparing cardiovascular parameters across the groups with and without transverse groove on the earlobe showed a higher rate of CAD as well as the higher number of involved coronary arteries than in the groups without transverse groove on the earlobe. Similarly, the presence of CAD and its higher severity were more revealed in patients with hair growth on the ear as compared to the group without this phenotype. According to multivariable logistic regression analysis and with the presence of baseline parameters, the presence of transverse groove on the earlobe and hair growth on the ear increased the risk for CAD by 2.4 and 4.4 fold, respectively. Conclusion: Along with classic cardiovascular risk factors, the role of growing hair on the ear and transverse groove on the ear to predict high risk for CAD should be considered. [GMJ.2020;8:e1443]
References
Vasan RS, Benjamin EJ. The future of cardiovascular epidemiology. Circulation. 2016; 133(25): 2626-33. https://doi.org/10.1161/CIRCULATIONAHA.116.023528PMid:27324358 PMCid:PMC4974092 Lee JT, Lawson KD, Wan Y, Majeed A, Morris S, Soljak M, et al. Are cardiovascular disease risk assessment and management programmes cost effective? A systematic review of the evidence. Prev Med. 2017; 99: 49-57. https://doi.org/10.1016/j.ypmed.2017.01.005PMid:28087465 Beyranvand MR, Piranfar MA, Mobini M, Pishgahi M. The relationship of st segment changes in lead avr with outcomes after myocardial infarction; A cross sectional study. Emerg. 2017; 5(1). Nerlekar N, Ha FJ, Cheshire C, Rashid H, Cameron JD, Wong DT, et al. Computed tomographic coronary angiography-derived plaque characteristics predict major adverse cardiovascular events: A systematic review and meta-analysis. Circ Cardiovasc Imaging. 2018; 11(1): e006973. https://doi.org/10.1161/CIRCIMAGING.117.006973PMid:29305348 Andelius L, Mortensen MB, Nørgaard BL, Abdulla J. Impact of statin therapy on coronary plaque burden and composition assessed by coronary computed tomographic angiography: a systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging. 2018; 19(8): 850-858. https://doi.org/10.1093/ehjci/jey012PMid:29617981 Kim C, Hong SJ, Shin DH, Kim JS, Kim BK, Ko YG, et al. Limitations of coronary computed tomographic angiography for delineating the lumen and vessel contours of coronary arteries in patients with stable angina. Eur Heart J Cardiovasc Imaging. 2015; 16(12): 1358-65. https://doi.org/10.1093/ehjci/jev100PMid:25925217 Kruk M, Wardziak Å, Mintz GS, Achenbach S, PrÄ™gowski J, RużyÅ‚Å‚o W, et al. Accuracy of coronary computed tomography angiography vs intravascular ultrasound for evaluation of vessel area. J Cardiovasc Comput Tomogr. 2014; 8(2): 141-8 https://doi.org/10.1016/j.jcct.2013.12.014PMid:24661827 Frank ST. Aural sign of coronary-artery disease. N Engl J Med 1973; 289: 327-8. https://doi.org/10.1056/NEJM197308092890622PMid:4718047 Higuchi Y, Maeda T, Guan JZ, Oyama J, Sugano M, Makino N. Diagonal earlobe crease are associated with shorter telomere in male Japanese patients with metabolic syndrome. Circ J. 2009; 73: 274-9. https://doi.org/10.1253/circj.CJ-08-0267PMid:19060421 Sapira JD. Earlobe creases and macrophage receptors. South Med J 1991; 84: 537-8. https://doi.org/10.1097/00007611-199104000-00038PMid:1826568 Shoenfeld Y, Mor R, Weinberger A, Avidor I, Pinkhas J. Diagonal ear lobe crease and coronary risk factors. J Am Geriatr Soc. 1980; 28: 184-7 https://doi.org/10.1111/j.1532-5415.1980.tb00514.xPMid:7365179 Iorgoveanu C, Zaghloul A, Desai A, Krishnan AM, Balakumaran K. Bilateral earlobe crease as a marker of premature coronary artery disease. Cureus. 2018; 10(5): e2616 https://doi.org/10.7759/cureus.2616 Kamal R, Kausar K, Qavi AH, Minto MH, Ilyas F, Assad S, et al. Diagonal earlobe crease as a significant marker for coronary artery disease: A case-control study. Cureus. 2017; 9(2): e1013. https://doi.org/10.7759/cureus.1013 Honma M, Shibuya T, Iwasaki T, Iinuma S, Takahashi N, Kishibe M, et al. Prevalence of coronary artery calcification in Japanese patients with psoriasis: A close correlation with bilateral diagonal earlobe creases. J Dermatol. 2017; 44(10): 1122-1128. https://doi.org/10.1111/1346-8138.13895PMid:28464401 Aizawa T, Shiomi H, Kitano K, Kimura T. Frank's sign: diagonal earlobe crease. Eur Heart J. 2018; 39(40): 3653. https://doi.org/10.1093/eurheartj/ehy414PMid:30020433 Hoffmann U, Massaro JM, D'Agostino Sr RB, Kathiresan S, Fox CS, O'Donnell CJ. Cardiovascular event prediction and risk reclassification by coronary, aortic, and valvular calcification in the Framingham Heart Study. J Am Heart Assoc. 2016; 5(2): e003144. https://doi.org/10.1161/JAHA.115.003144 Mosepele M, Hemphill LC, Palai T, Nkele I, Bennett K, Lockman S, et al. Cardiovascular disease risk prediction by the American College of Cardiology (ACC)/American Heart Association (AHA) Atherosclerotic Cardiovascular Disease (ASCVD) risk score among HIV-infected patients in sub-Saharan Africa. PloS One. 2017; 12(2): e0172897. https://doi.org/10.1371/journal.pone.0172897PMid:28235058 PMCid:PMC5325544 Poppe KK, Doughty RN, Wells S, Gentles D, Hemingway H, Jackson R, et al. Developing and validating a cardiovascular risk score for patients in the community with prior cardiovascular disease. Heart. 2017; 103(12): 891-2. https://doi.org/10.1136/heartjnl-2016-310668PMid:28232378 Budoff MJ, Young R, Burke G, Jeffrey Carr J, Detrano RC, Folsom AR, et al. Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA). Eur Heart J. 2018; 39(25): 2401-8. https://doi.org/10.1093/eurheartj/ehy217PMid:29688297 PMCid:PMC6030975 Bansal P, Chaudhary A, Wander P, Satija M, Sharma S, Girdhar S, et al. Cardiovascular risk assessment using WHO/ISH risk prediction charts in a rural area of North India. J Res Med Dent Sci. 2016; 4(2): 127-31. https://doi.org/10.5455/jrmds.20164210 Ziyrek M, Åžahin S, Özdemir E, Acar Z, Kahraman S. Diagonal earlobe crease associated with increased epicardial adipose tissue and carotid intima media thickness in subjects free of clinical cardiovascular disease. Turk Kardiyol Dern Ars. 2016; 44(6): 474-80. https://doi.org/10.5543/tkda.2016.37806PMid:27665328 Eroglu S, Sade LE, Yildirir A, Bal U, Ozbicer S, Ozgul AS, et al. Epicardial adipose tissue thickness by echocardiography is a marker for the presence and severity of coronary artery disease. Nutr Metab Cardiovasc Dis. 2009; 19(3): 211-7. https://doi.org/10.1016/j.numecd.2008.05.002PMid:18718744 Verma SK, Khamesra R, Mehta LK, Bordia A. Ear-lobe crease and ear-canal hair as predictors of coronary artery disease in Indian population. Indian Heart J. 1989; 41(2): 86-91. Oh HS, Smart RC. An estrogen receptor pathway regulates the telogen-anagen hair follicle transition and influences epidermal cell proliferation. Proc Natl Acad Sci U S A. 1996; 93(22): 12525-30. https://doi.org/10.1073/pnas.93.22.12525PMid:8901615 PMCid:PMC38025 Little JC, Redwood KL, Granger SP, Jenkins G. In vivo cytokine and receptor gene expression during the rat hair growth cycle: Analysis by semi-quantitative RT-PCR. Exp Dermatol. 1996; 5(4): 202-12. https://doi.org/10.1111/j.1600-0625.1996.tb00118.xPMid:8889467 Agouridis AP, Elisaf MS, Nair DR, Mikhailidis DP. Ear lobe crease: a marker of coronary artery disease? Arch Med Sci. 2015; 11(6): 1145. https://doi.org/10.5114/aoms.2015.56340PMid:26788075 PMCid:PMC4697048 Kumar A. Frank's sign and coronary artery disease in Indian population. Heart India. 2016; 4(4): 129. Wagner RF Jr, Reinfeld HB, Wagner KD, Gambino AT, Falco TA, Sokol JA, et al. Ear-canal hair and the ear-lobe crease as predictors for coronary-artery disease. N Engl J Med. 1984; 311(20): 1317-8. https://doi.org/10.1056/NEJM198411153112012PMid:6493285 Ali RA, Asadollah M, Hossien RA. The role of unknown risk factors in myocardial infarction. Cardiol Res. 2010; 1(1): 15-19.