There is a medical obsession with determining who is at risk for a disease. Cancer, heart disease, osteoporosis and stroke are examples.
Arguably, none of us sign up for chronic disease. It’s not like you fill out a form when you’re 18 and check off that you’d like to have open heart surgery at 55 because the scar from the sternotomy seems like a great way to pick up chicks.
And yet, from a bird’s eye view, it may seem like we really are making a conscious choice for chronic disease. Fast food, sedentary lifestyles, drinking out of plastic water bottles, avoiding berries and vegetables like taxes on April 15 and using artificial sweeteners are all choices that clearly increase the risk of chronic diseases.
As a society we continue to choose these behaviors. Medicine’s answer to this is to look for markers in the blood or on some type of diagnostic device (MRI, CT, EKG, etc…) to try to predict whether or not someone is going to have a chronic disease event like a fracture, heart attack, stroke or cancer diagnosis. Then, if we find these markers, we can use drugs to try to stem the likelihood of having one of these events.
It’s really pretty screwed up if you think about it.
Consider this. You KNOW you need oil in your car, but it’s just such a hassle to go to the shop, wait while you have the service done and on top of all that, you have to pay for it. Instead of changing the oil you just keep your mechanic’s phone number on speed dial. Check engine light on? Just cover it up with an ASPCA sticker. Car beginning to smoke? Just don’t run it in a closed garage. Starting to overheat? Just move to Minnesota. All of this in an attempt to put off the inevitable point at which the engine blows.
Luckily, at this point we can replace the engine and begin the process all over again. Even better, we can get your insurance company or even the government to pay for the new engine. It’s a good day.
But seriously–does this just not sound like the most stupid approach you could think of?
Somehow, though, when it comes to our health we take this exact approach. Don’t make the simple fixes early on–just cover up symptoms as they arise until the inevitable happens. Then we address the inevitable and continue back on the same approach that put us there in the first place.
So long as medicine continues to follow this model, identifying those at risk gives us the advantage of being able to tell who we should medicate. If that sounds a little cynical and simplistic, that’s because it is. Untold BILLIONS of research dollars are spent trying to decide if we should medicate Joe when his cholesterol is at 235 or wait until it climbs to 245. Billions. And it’s all because we have to decide when the side effects of a treatment are outweighed by the benfits.
For me personally, when I’m talking to patients about improving their lifestyles, all that research doesn’t mean squat. That’s because there is no downside to exercise, cleaning up the diet and stressing less. None. So it doesn’t matter if a patient starts these changes at 245, 235 or even at a cholesterol of 165. It’s a completely different philosophy.
Either way, all of this Ranting brings me to this particular article. In it, researchers looked at how much the presence of a diagonal ear crease increased the risk of heart disease prediction using the Diamond-Forrester classification.
The DF classification has been around for decades and uses age, sex and symptoms along with four diagnostic tests (stress EKG, cardiokymography, thallium scintigraphy and cardiac fluoroscopy) to predict someone’s risk of having a heart attack. Just like every other scoring system, it misses cases that are there and misdiagnoses cases that aren’t. For this reason, anything that can be done to improve the accuracy of this classification is helpful.
Enter the diagonal earlobe crease. I have written about the strange link between the presence of a diagonal earlobe crease and heart disease in a previous article that can be read by clicking here.
Researchers looked at 199 patients with chest pain and evaluated how effective the DF classifcation, the diagonal earlobe crease and the mixture of the two at determining who had greater than 50% blockage of the coronary blood vessel on CT scanning. Here’s what they found:
- Those who had a diagonal earlobe crease were a striking 360% more likely to have advanced plaquing in their coronary blood vessels.
- However, when they added the DF classification to the earlobe crease, this group jumped up to a 560% higher risk.
In other words, merely looking at the patient was able to much more strongly predict whether or not a patient was really at risk of having advanced heart disease.
Before you go running off to look in the mirror, consider this. Just because you have an earlobe crease does NOT mean you are doomed to a heart attack. But what it may mean is that you need to be that much more diligent with making the right choices for your lifestyle.