DiagnosticsPublished: September 2026·Updated: September 2026·8 min read

Frank's Sign: The Earlobe Crease Linked to Heart Disease

Frank's sign is a diagonal crease running across the earlobe, and for fifty years doctors have noticed it turning up more often in people with coronary artery disease. It is named after Dr Sanders Frank, who described it in 1973 in patients with angina. The association is real but modest: a crease is not a diagnosis, and plenty of healthy older people have one. What it genuinely offers is a free, visible nudge — if you or your barber notices a deep line across your earlobe, it is worth checking your blood pressure, cholesterol and blood sugar properly. In Singapore we treat it as a prompt for a proper cardiovascular risk assessment, nothing more and nothing less.

Dr. Peter Chang

Triple Board-Certified Cardiologist & Vascular Specialist

What Frank's Sign Actually Is

Frank's sign — also called a diagonal earlobe crease — is a wrinkle that runs backwards and slightly downwards across the fleshy part of the ear, roughly at 45 degrees, from the opening of the ear canal towards the outer edge of the lobe. It is a true crease in the skin, present when the ear is relaxed, not a temporary line from sleeping on that side.

Dr Sanders Frank first reported it in 1973 among patients with angina, and it has been studied ever since. The short version: it is associated with coronary artery disease and with broader cardiovascular risk, but the link is loose enough that it cannot diagnose anything on its own. In our Singapore clinic we treat it as one more clue on the examination, not a verdict.

How to Check for Frank's Sign on Yourself

Stand in front of a mirror in good light with your head level, and look at both earlobes in turn. A diagonal earlobe crease is easiest to see if you gently tilt the ear forward. Note four things, because they matter for how much weight to give it:

Length: a partial crease covers part of the lobe; a full crease runs corner to corner
Depth: a faint line means little; a deep, sharply cut furrow is the one studies pay attention to
One ear or both: bilateral creases are reported more often with heart disease than a single-sided crease
Age context: under about 60 it is more meaningful; past 70 a great many people have one regardless of their heart

What the Evidence Says About the Crease and Your Arteries

The honest summary is that the association is consistent but weak. A systematic review of 13 studies and 3,951 patients found sensitivity ranging from 26% to 90% and specificity from 32% to 96% for coronary artery disease — wildly variable, and not reliable enough to rule anything in or out. The authors concluded its presence or absence ‘should not affect clinical management’.

Where it earns its keep:

A meta-analysis of cardiovascular events found a modest but real association, with an odds ratio around 1.45
Several studies link the diagonal earlobe crease to carotid plaque, prior stroke, and a higher coronary calcium score
In some analyses it stays linked to heart disease even after adjusting for age, sex, diabetes, hypertension and smoking; in others the link vanishes once age is accounted for

Why It Might Happen: Elastic Fibres and Small Vessels

Nobody has proven the mechanism, but the leading ideas share a theme: the earlobe and the heart's small vessels may age in parallel. The earlobe has no cartilage and a limited, end-artery blood supply with few backup routes, a bit like parts of the coronary microcirculation. Proposed explanations include loss of elastic fibres and myoelastofibrosis at the base of the lobe, degeneration of collagen, general skin ageing, and shortening of telomeres — the protective caps on chromosomes — in the affected tissue.

None of these is specific to high cholesterol. The crease is better understood as a marker of vascular ageing and cumulative risk-factor exposure than as a footprint of any single problem. That is also why, in Singapore, we read it alongside everything else rather than in isolation.

If You Have Frank's Sign: What to Check in Singapore

A crease is a reason to get a proper cardiovascular risk assessment, not a reason to panic. If you have never had one, or it has been a few years, this is a sensible prompt to book it.

A standard work-up includes blood pressure, a fasting lipid panel (ideally with ApoB), fasting glucose or HbA1c, body-mass index and waist measurement, and a resting ECG. Depending on your age and risk factors, we may add a coronary artery calcium score — a two-minute CT that directly shows whether calcified plaque is present. At our clinic at Paragon Medical Centre on Orchard Road, a first consultation with bloods runs roughly SGD 150 to SGD 350, and a calcium score about SGD 250 to SGD 500. The crease is free; acting on it need not be expensive.

Lowering the Risk the Crease Points To

If the assessment turns up raised cholesterol, blood pressure or glucose, the response is the same as for anyone with those findings — and it works regardless of what your ears look like:

Get LDL cholesterol to target — diet first, a statin if your risk or numbers warrant it
Keep blood pressure under about 130/80, with less salt, more movement, and medication if needed
150 minutes of brisk activity a week and two resistance sessions — a brisk loop of the neighbourhood or East Coast Park counts
A Mediterranean-style diet: more vegetables, legumes, nuts, oily fish and olive oil; less processed meat and refined carbohydrate
Stop smoking, and keep alcohol modest

When to See a Cardiologist

See a cardiologist rather than relying on a general check-up if the risk assessment is abnormal, if you have symptoms — chest tightness or breathlessness on exertion, unusual fatigue — or if you have a strong family history of early heart attack or stroke alongside Frank's sign. A crease with entirely normal numbers and no symptoms needs no cardiology referral at all; annual monitoring with your GP is enough.

In Singapore you can see a cardiologist privately without a referral. Bring any recent blood results and a list of your medications. The visit is short, and the point is simple: turn an incidental observation into a clear, current picture of your cardiovascular risk.

Frequently Asked Questions

Common Questions About Frank's Sign

Is an earlobe crease a sign of heart disease?

It can be a clue, not proof. A diagonal earlobe crease, or Frank's sign, turns up more often in people with coronary artery disease, but the link is weak and many healthy older people have one. Treat it as a reason to have your blood pressure, cholesterol and blood sugar checked, not as a diagnosis.

What does Frank's sign look like?

A crease running diagonally across the earlobe at roughly 45 degrees, from the ear canal towards the outer lower edge, present when the ear is relaxed. It can be partial or run corner to corner, faint or deep, and on one or both ears. Deep, full, bilateral creases are the ones studies link most often to heart disease.

How do I check for Frank's sign at home?

In a mirror, in good light, with your head level, look at both earlobes and tilt each ear gently forward. A true crease stays put; a soft line that fades within an hour of waking is just a sleep mark. If you spot a firm diagonal groove, photograph it in daylight and show your doctor.

Can you have an earlobe crease and a healthy heart?

Absolutely. The crease becomes very common with age and appears in plenty of people with normal arteries, which is exactly why it cannot diagnose anything. Plenty of people with serious coronary disease have smooth earlobes too. The only way to know your heart's state is to measure it.

Does Frank's sign mean I need a heart scan in Singapore?

Not automatically. If you have a crease, we would start with blood pressure, a lipid panel, glucose and an ECG. A coronary calcium score is added when your age and risk factors put you in the grey zone where it would change the decision to start a statin, not simply because of an ear crease.

How much does a cardiovascular risk assessment cost in Singapore?

As a rough guide, a first cardiologist consultation with blood tests runs about SGD 150 to SGD 350, and a coronary artery calcium score around SGD 250 to SGD 500. Basic risk screening through a GP or a polyclinic is cheaper. Medisave can often be used towards diagnostic testing when it is clinically indicated.