Study of the prevalence of Frank’s sign in a general population

Background: Frank’s sign is a diagonal crease in the earlobe that extends from the tragus to the inferior-posterior auricle’s edge. Described as a predictor of cardiovascular diseases (CVDs), it was considered an independent cardiovascular risk factor (CRF) and associated with cerebrovascular events and cognitive impairment (CI). Objectives: To assess the prevalence of Frank’s sign in a general population aged 60 years or older regardless of the presence of CRFs and to relate the presence of this sign with epidemiological and clinical aspects. Design and setting: This is an analytical, observational and cross- sectional study accomplished in ABC Region and in Itapecerica da Serra (Greater São Paulo). Methods: 500 individuals aged 60 years or older randomly recruited had their ears photographed, responded to either Mini Mental State Examination or Montreal Cognitive Assessment depending on education achievement. Results: 57% were women; 57% were white, 39% black and 4% asian; 64% had the sign; Frank’s sign was associated with dyslipidemia and almost with hypertension, but not with cardiovascular events or CI. Conclusions: 1. Frank’s sign was more prevalent in older people and in the white population and, for the first time, in women. 2. There is a pattern in the sign prevalence in Greater São Paulo, which differs from the international one. 3. Frank’s sign may be more sensitive to CVDs in hospitalized patients than in the general population and it can be a bias in literature. 4. Prospective studies could assure whether this sign is a marker for CVDs in this population.