The association between diagonal earlobe crease (ELC) and
cardiovascular diseases (CVD) was first reported in 1973 .
Subsequently, several studies have found a significant associ-
ation between the presence of ELC and CVD [2, 3]. Moreover,
it has been reported  that the association between ELC and
carotid intima-media thickness (IMT), which is widely used
as a surrogate marker for atherosclerotic disease, has been
shown to predict the incidence of CVD events [5-7] and has
been associated with cardiovascular risk factors [8, 9].
Atherosclerosis is an essential process in the development
OBJECTIVES: Several studies have found a significant association between the presence of earlobe crease
(ELC) and cardiovascular disease (CVD). Brachial-ankle Pulse Wave Velocity (baPWV) is a non-invasive and
useful measure of arterial stiffness predicting cardiovascular events and mortality. However, few studies have
reported the relationship between ELC and baPWV as a new measure of arterial stiffness. The purpose of this
study was to determine whether ELC is related to baPWV in non-diabetic, non-hypertensive, and apparent-
ly healthy Korean adults.
METHODS: A cross-sectional study was conducted on 573 non-hypertensive, non-diabetic Korean adults aged
20-80 yr. Subjects were stratified into three groups according to gender and menopausal status. baPWV was
measured by an automatic waveform analyser. The association between ELC and baPWV was assessed by mul-
tiple linear regression analysis after adjusting for conventional cardiovascular disease risk factors including age,
gender, blood pressure, lipid profile, and smoking status etc.
RESULTS: The overall frequency of ELC was 19.02% and the subjects with ELC showed significantly higher
mean baPWV (p<0.0001). Multiple linear regression of subjects revealed that the presence of ELC was inde-
pendently associated with baPWV (male, p<0.0001; premenopausal female p=0.0162; postmenopausal female
CONCLUSION: ELC had a significant correlation with baPWV, independently controlling for other classical
cardiovascular risk factors in adults aged 20 yr or older. ELC is an important surrogate marker of increased
arterial stiffness as measured by baPWV in Korean adults. (Epidemiol Health 2009;31:e2009002).
KEY WORDS: Association, Earlobe crease, Brachial-ankle pulse wave velocity, Korean
Relationship Between Earlobe Crease and Brachial-
ankle Pulse Wave Velocity in Non-hypertensive,
Non-diabetic Adults in Korea
Sang In Choi1, Hee Cheol Kang1, Choon Ok Kim1, Seung Beom Lee1, Won Ju Hwang2,
Dae Ryong Kang3
1Department of Family Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea; 2Department of Community
Health Systems, University of California San Francisco, CA, USA; 3Graduate School of Public Health, Yonsei University, Seoul, Korea
Epidemiology and Health
Volume: 31, Article ID: e2009002, 6 pages
Epidemiology and Health
Correspondence to :
Dae Ryong Kang
Graduate School of Public Health, Yonsei University,
250 Seongsan-no, Seodaemun-gu, Seoul 120-752, Korea
Tel : +82-2-2228-0456 Fax : +82-2-2227-7744
E-mail : email@example.com
Received: Jul 14, 2009, Accepted: Aug 3, 2009, Published: Oct 12, 2009
This article is available from: http://e-epih.org/.
2009, Korean Society of Epidemiology
This is an open-access article distributed under the terms of the
Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the
original work is properly cited.
correlation with baPWV independent of other conventional
cardiovascular risk factors in adults aged 20 yr and older.
ELC is an important predictor of increased arterial stiffness
measured by baPWV in asymptomatic subjects in spite of the
limitations of this study. The contribution of ELC-related in-
crease in baPWV to the prognosis of CVD should be further
evaluated before these results can be extrapolated to other
CONFLICTS OF INTEREST
We have no source of funding, conflicts of interest and
financial to disclose.
We especially thank Dr Duk Chul Lee, Dr In Cheol Hwang,
Dr Hye Soon Park (for providing significant advice), Dr Seung
Yoon Lee, and Dr Hee Seok Park (for managing data) for their
cooperation and support for this study. We thank Ms Sydney
Kim for her English editorial assistance.
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