Middle-aged John has endured low-grade worry ever since his wife, a nurse, looked at his earlobes one day a dozen years ago and said she was concerned he might prematurely have a heart attack.
Like an unknown but large proportion of men, John has a slight crease at the bottom of each of his ears, just below where the lobe meets the skin of his cheeks. And his wife wasn't responding to some weird folklore, she was reacting to a medical theory credible enough to have appeared in major journals repeatedly since it was first suggested in a letter to the editor of the New England Journal of Medicine in 1973.
Now, a research team at the University of Massachusetts says the concern has been for naught. But the controversy still may not have been resolved. In fact, the doctor who started the debate 14 years ago says that, despite the new finding, he thinks the accuracy of the earlobe theory is "unquestionable."
The author of the initial 1973 letter was Dr. Sanders Frank, now a Monterey Park pulmonary medicine specialist. Frank was an Air Force doctor at the time, he said in a telephone interview, and got interested in the issue when he noted a correlation between earlobe creases and coronary artery disease in his military patients--all of whom were young enough that heart problems would not be expected.
The theory has been that earlobe creases are a tangible indicator of heart disease risk. Causation was never established, but studies and papers over the years have noted a seeming statistical association between earlobe creases and heart attacks. The theory got wide exposure in four Peanuts cartoon strips in 1985 that suggested a department store Santa Claus had lobe creases that led to a heart attack.
Now, though, a University of Massachusetts Medical School team has conducted what its leader says is the most sophisticated study of the alleged association and concluded that earlobe creases are not a characteristic of men at risk of heart disease. Rather, agreeing with previous skepticism voiced about the association, the Massachusetts researchers say earlobe creases are a simple feature of the aging process in some men. The study may not end the controversy, but the head of the project believes the data is solid enough that it ought to.
To reach its conclusion, the Massachusetts team studied 261 consecutive male patients undergoing diagnostic testing for possible heart disorders, dividing the patients into four age groups ranging from under 50 to over 70. Not only were men with earlobe creases no more likely than men without them to have coronary disease, but men without creases had slightly greater prevalances of disease than men who did. The findings appear in the current issue of Archives of Internal Medicine.
Priscilla Brady, a research nurse who headed the research team, said she urged that the study be conducted essentially because of people like John. "It's something that's been written about a lot," Brady said in a telephone interview. "A lot of times, patients will ask, 'Does this mean I'm really sick?' "
Not so fast, says Frank. Despite the new research conclusion, he said, "I think the association (of creases to heart disease) is unquestionable."
Frank said he has continued to follow research reports and has tabulated that, in what he says are 30 published studies in the medical literature, the association has been confirmed in 25 and discounted in only five. Moreover, he contended, the studies together show that in patients undergoing cardiac catheterization--testing when advanced heart disease is seriously suspected--86% of patients with creases test positive as opposed to between 30% and 40% of patients without such ear features.
"I think it can be unequivocally said," Frank observed, "that where I initially thought (the crease) was a sign patients probably had other risk factors for coronary artery disease, it turns out that the crease is a risk factor, per se , independent of age, elevated cholesterol, family history of heart disease, diabetes, high blood pressure and all of those things we consider to be risk factors."
Why do only men seem to have the crease-heart disease risk? Frank conceded he has no idea.