Most people think of heart disease as something detected through blood tests, scans, or hospital visits. But sometimes, the body shows subtle outward signs that may hint at what’s happening inside. One of these physical clues is known as Frank’s Sign—a small crease on the earlobe that has drawn medical attention for decades.

What Is Frank’s Sign?

Frank’s Sign, medically called the diagonal earlobe crease (DELC), is a diagonal line running across the earlobe at an angle of about 30–45 degrees, usually extending from the tragus to the lower edge of the lobe.

The sign was first described in 1973 by Sanders T. Frank, who observed the crease in patients suffering from angina pectoris. Unlike normal skin wrinkles, this crease typically runs through the full thickness of the earlobe and remains visible even when the ear is gently stretched.

Why Would an Earlobe Matter?

The earlobe has a unique structure. It contains no cartilage and is supplied by very small end arteries without backup circulation. Because of this, changes in blood flow or vessel health may show up there earlier than in other parts of the body.

Researchers believe Frank’s Sign may reflect microvascular damage—the same type of blood vessel changes seen in atherosclerosis, the process that underlies many forms of heart disease.

Conditions Linked to Frank’s Sign

Frank’s Sign is not a diagnosis, but studies have found associations with several cardiovascular and metabolic conditions, including:

• Coronary artery disease
• History of heart attack
• Peripheral arterial disease
• Ischemic stroke
• High blood pressure
• Type 2 diabetes
• Metabolic syndrome

People with bilateral creases (on both earlobes) appear to have a stronger association than those with a crease on only one side.

What Causes the Crease to Form?

Doctors do not yet agree on a single cause, but leading theories include:

• Microvascular ischemia: Reduced blood supply to the earlobe’s tiny vessels
• Systemic vascular aging: Similar structural changes occurring in arteries throughout the body
• Shortened telomeres: Research suggests people with the crease may show signs of accelerated biological aging
• Loss of elastin and collagen: Changes also seen in aging or diseased blood vessels

Together, these theories point toward Frank’s Sign being a marker of vascular health, rather than a simple effect of aging alone.

Does Age Matter?

Yes. Frank’s Sign becomes more meaningful in people under 60, where normal aging is less likely to explain the crease. In older adults, its significance is reduced because earlobe changes are more common with age.

Different Patterns, Different Risk

The appearance of the crease can vary, and clinicians sometimes consider:

• Partial vs. complete crease
• Shallow vs. deep
• Unilateral vs. bilateral

A deep, complete crease on both earlobes may raise more concern than a faint, partial crease on one side.

What Frank’s Sign Does Not Mean

It’s important to clear up common misunderstandings:

• It does not prove heart disease
• It does not replace medical tests
• It does not mean immediate treatment is needed
• It is not caused by earrings, sleep position, or body weight

Should You Be Concerned?

If you notice a diagonal crease on your earlobe—especially if you’re under 60 or have risk factors such as smoking, diabetes, high blood pressure, or a family history of heart disease—it may be worth mentioning it during a medical check-up.

Doctors may then decide whether further evaluation, such as blood tests or heart screening, is appropriate.

The Bottom Line

Frank’s Sign is best viewed as a visible reminder that cardiovascular health affects the entire body. While it cannot diagnose disease, it may serve as a prompt for early awareness and prevention.