Title:
Association Between Coronary Artery Atherosclerosis and Diagonal Earlobe Crease (Frank’s Sign): A Prospective Autopsy Study in Sri Lanka

Authors:
Lowe W.M.T., Hulathduwa S.R., Ekanayake E.M.K.B, Sri Lanka

Abstract:

Frank’s sign (FS) or the diagonal earlobe crease (DELC) was first described in 1973, with histopathological findings showing myoelastofibrosis, diffuse fibrosis and Wallerian-like degeneration in the underlying arterial vessels at the base of the crease. Recent studies have suggested a potential association between the presence of DELC and an increased risk of coronary artery atherosclerosis (CAA). This study was aimed to investigate the association between the presence of FS with age, CAA and cause of death and explore associations with comorbidities like ischemic heart disease (IHD), hypertension, dyslipidemia (DL) and diabetes mellitus (DM). The severity of Frank’s sign was assessed and correlated with macroscopic narrowing of the coronary arteries, cause of death and the presence of major cardiovascular risk factors (IHD, hypertension, dyslipidemia and diabetes) in 224 autopsy samples at Colombo South Teaching Hospital, Kalubowila, Sri Lanka, conducted during 2024-2025. The study included 224 cases (152 males, 72 females) above the age of 30 years, with a mean age of 64 years and a mean left-ventricular thickness of 15 mm. There was a statistically significant association between FS and the age (p = 0.001), with individuals with prominent FS being older on average. Cardiac-related deaths were significantly commoner among those with Frank’s sign compared to non-cardiac causes (p=0.002).  The severity of Frank’s sign showed a moderate, positive and statistically significant correlation with major coronary artery narrowing and occlusion (p<0.001). Significant associations were also observed between higher severity/degree of Frank’s sign and a history of hypertension (p=0.010), IHD (p=0.002) and dyslipidemia (p=0.005). However, the association with DM was not statistically significant (p=0.053). These findings support the use of Frank's sign as a potential external indicator for the risk and severity of CAA.

DOI: http://dx.doi.org/10.51505/ijmshr.2026.10504