Evaluation of the presence of frank sign as a prognostic factor in ischemic heart diseases among smokers and non-smokers

Objective: This study aims to investigate the effect of cigarette consumption, one of the cardiovascular risk factors, on the formation of the Frank's sign (diagonal earlobe crease, DELC), which is considered a prognostic marker for ischemic heart diseases. It also aims to examine the relationship between DELC and cardiovascular diseases, risk factors, and certain health variables. Materials and Methods: Our study is a prospective, cross-sectional, controlled study conducted between September 1, 2024, and March 1, 2025, with middle-aged individuals (aged 40–59 years) who applied to the units affiliated with the Department of Family Medicine, Faculty of Medicine, Samsun University. Sociodemographic data, clinical history, and family history of participants were obtained through interviews. Bilateral ear photographs were taken and archived for evaluation using the Modified Patel-Lopez classification. Statistical analyses were performed using SPSS 26.0 for Windows. Results: Our study was conducted with a total of 404 participants (152 in the study group and 252 in the control group), with a mean age of 49,4±5,4 years. Of these, 51,2% were men and 85,4% were married. Among the participants, 37,6% were current smokers, and 16,8% had quit smoking. In the study population, unilateral DELC was observed in 14,4% (58 individuals), and bilateral DELC was observed in 31,9% (129 individuals). A significant difference was found between DELC and age and age groups (p<0,001). No significant relationship was found between DELC and gender and marital status. Although DELC was found to be statistically associated with weight (p=0,021), no similar association was observed with BMI or obesity. DELC did not show any significant association with cardiovascular diseases, their risk factors, prescribed medications or family history. Among smokers, 32,8% had unilateral and 40,3% had bilateral DELC. While no statistical association was identified between DELC and smoking status or duration of exposure among former smokers, a significant relationship was observed with the pack-year variable (p=0,045). Conclusion: As a result of our study, no relationship was found between smoking status and the presence of Frank sign. However, a statistically significant association was found between DELC and the pack-year variable, which more qualitatively reflects the duration and intensity of smoking exposure. This highlights the cumulative effect of smoking. For primary care physicians, identifying the presence of DELC in smokers may be considered a rapid, easy-to-apply, and non-invasive screening method that reflects cardiovascular disease burden. Keywords: Frank's Sign, DELC, Smoking, Cardiovascular Diseases