After years of seeing yourself in the mirror, you’re probably pretty familiar with your appearance. So imagine your surprise when one day you look in the mirror and see an unfamiliar crease in your earlobe. What you may be seeing is called Frank’s sign, a diagonal earlobe crease (DELC). But what is Frank’s sign, and what does it mean for your health?

In this article, we’ll discuss DELCs and their possible connection to different types of heart disease. We’ll also talk a bit about what you should do if you notice Frank’s sign on one or both of your ears.

What Is Frank’s Sign?

Frank’s sign is a wrinkle or crease in the earlobe. It goes from the outer edge of your earlobe toward the opening of your ear canal. You can have this crease in one or both of your earlobes. The diagonal earlobe crease can cover all or just part of the earlobe. It can also be shallow, like a wrinkle, or deep, like a fold in the ear.

Frank’s sign is named for Dr. Sanders T. Frank. In 1973, Dr. Frank noticed this diagonal earlobe crease in 20 people he was treating for angina (chest pain). Since then, researchers in the field of cardiology have studied its association with heart disease. While the exact mechanism remains unclear, the prevalence of Frank’s sign has been linked to an increased risk of cardiovascular disease — particularly ischemic heart disease, which is characterized by reduced blood flow to the heart muscle.

What Does Having Frank’s Sign Say About Your Risk of Heart Disease?

Some research suggests that having Frank’s sign in one or both earlobes indicates an increased risk of heart disease. In particular, some studies have looked at coronary artery disease (CAD) and the diagonal earlobe crease.

Frank’s Sign and Coronary Artery Disease

Coronary artery disease is a type of heart disease affecting the blood vessels of the heart. The coronary arteries supply blood to the heart muscle so it can continue beating.

However, sometimes fats and cholesterols build up on the inside of blood vessels. This is called atherosclerosis, and it causes stenosis (narrowing of the blood vessels). When this happens in the coronary arteries, it’s called coronary artery disease. Over time, this narrowing or blockage of the coronary arteries reduces the blood flow to the heart muscle, which can lead to a heart attack.

One research study found that people with people with Frank’s sign were more likely to have coronary artery disease than those without an earlobe crease. Those with a crease on just one ear were about three times more likely to have CAD than the general population. Those with bilateral diagonal earlobe creases (creases on both ears) were nearly six times more likely to have CAD. Additionally, the severity of atherosclerosis (blockages in the coronary arteries) was greater in people with bilateral creases. This may suggest that Frank’s sign could signal more severe cardiovascular events, such as heart attacks.

Other researchers found that people with diagonal earlobe creases were more likely to experience serious cardiac events, such as myocardial infarctions (heart attacks) or the need for coronary artery bypass surgery. They also found that those with the crease were at a higher risk of dying from heart-related issues like heart attacks or heart failure, even if they didn’t have known coronary artery disease when the study began.

Finally, some researchers have connected the severity of the earlobe crease with cardiovascular risk factors. These studies show that people with Frank’s sign on only one ear had a lower risk of coronary heart disease than people with it on both ears. People with long, deep earlobe creases have the highest cardiovascular risk.

Frank’s Sign and Other Cardiovascular Diseases

While most research has focused on Frank’s sign and coronary artery disease, it’s also been linked to other cardiovascular diseases. Peripheral artery disease is like coronary artery disease — however, narrowed blood vessels are in the arms and legs rather than the heart.

One study found that people with peripheral artery disease were more likely to have diagonal earlobe creases than people without the disease. Scientists have also noted that Frank’s sign is more common in people with cerebrovascular disease (strokes).

Does Having Frank’s Sign Mean You Have Heart Disease?

Not all research has shown that Frank’s sign indicates a higher risk for cardiovascular disease. One study suggests that the association between Frank’s sign and coronary artery disease is coincidental since both conditions become more common with age. Another study also found that Frank’s sign doesn’t predict coronary artery disease in people with type 2 diabetes.

Outside of cardiovascular disease, there are other factors that affect your likelihood of having Frank’s sign. For instance, diagonal earlobe creases are more common in men than in women, according to research cited in the journal Cureus. Frank’s sign is also more common in people 60 and up and in people who smoke. Because of this, some researchers think that having Frank’s sign may not be sufficient for determining heart disease risk.

Finally, it’s important to remember that having Frank’s sign doesn’t guarantee that you have heart disease. It might mean, however, that you have a higher risk of heart disease than someone who doesn’t have diagonal earlobe creases.

How Are Your Ears Connected to Heart Disease?

Scientists don’t fully understand why there might be a connection between earlobes and heart disease, but one theory suggests that it’s related to blood flow. Both the earlobes and the coronary arteries are supplied by “end arteries,” which means they each have a single source of blood. If these arteries become blocked, the tissue they supply may not get enough oxygen-rich blood. In the coronary arteries, this can lead to heart disease. In the earlobes, reduced blood flow could potentially cause changes in the skin, such as the formation of a diagonal crease.

Other scientists think that changes in the structure of blood vessels cause Frank’s sign. Healthy blood vessels have a protein called elastin that helps the blood vessels stretch. However, tissue samples from people with Frank’s sign show that these elastin proteins can break down. Elastin breakdown is also seen in blood vessel aging, making elastin a possible bridge between Frank’s sign and coronary artery disease.

Some scientists think that lower levels of certain hormones cause early aging in both the ear and the coronary arteries. More research is needed to understand the connection between the ears and heart disease.

What Should You Do if You Find a Crease in Your Earlobe?

If you or a family member notice a diagonal earlobe crease, there's no need to assume that it’s related to heart disease. As explained earlier, the link between diagonal earlobe creases and heart disease isn’t fully understood. However, it’s a good idea to discuss your concerns with your primary care doctor or cardiologist, especially if you have a family history of heart disease or conditions like hypertension (high blood pressure). Be sure to talk to your doctor right away if you are having any symptoms of heart disease.

Your health care provider can help you determine if you’re at high risk of cardiovascular disease. They can also recommend ways to improve your heart health. You should always follow the medical advice of your health care provider.

Talk With Others Who Understand

MyHeartDiseaseTeam is the social network for people with heart disease and their loved ones. On MyHeartDiseaseTeam, more than 61,000 members come together to ask questions, give advice, and share their stories with others who understand life with heart disease.

Do you have a diagonal earlobe crease, also known as Frank’s sign? Do you have more questions about your risk of heart disease? Share your experiences and questions in the comments below, or start a conversation by posting on your Activities page.