CLINICAL SCIENCE
Association between ear creases and peripheral arterial disease
Paulo Müller Ramos
, Juliana Hammoud Gumieiro, Hélio Amante Miot
Corresponding author
São Paulo State University – Dermatology, Botucatu, São Paulo, Brazil.
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A: average axonal diameter; B: average myelinated fiber diameter; C: average myelin sheath thickness. Data are expressed as means ± SEM. a <span class="elsevierStyleItalic">P</span><0.05 <span class="elsevierStyleItalic">vs.</span> distal portion in the N and TN groups; b <span class="elsevierStyleItalic">P</span><0.05 <span class="elsevierStyleItalic">vs.</span> proximal portion in the same group; c <span class="elsevierStyleItalic">P</span><0.05 <span class="elsevierStyleItalic">vs.</span> distal portion in the N, TN, D, TD groups; d <span class="elsevierStyleItalic">P</span><0.05 <span class="elsevierStyleItalic">vs.</span> proximal portion in the N, TN, D, TD groups; e <span class="elsevierStyleItalic">P</span><0.05 <span class="elsevierStyleItalic">vs.</span> proximal portion in the TNC and TDC groups.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Tais Malysz, Jocemar Ilha, Patrícia Severo do Nascimento, Kátia De Angelis, Beatriz D'Agord Schaan, Matilde Achaval" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Tais" "apellidos" => "Malysz" ] 1 => array:2 [ "nombre" => "Jocemar" "apellidos" => "Ilha" ] 2 => array:2 [ "nombre" => "Patrícia Severo" "apellidos" => "do Nascimento" ] 3 => array:2 [ "nombre" => "Kátia" "apellidos" => "De Angelis" ] 4 => array:2 [ "nombre" => "Beatriz D'Agord" "apellidos" => "Schaan" ] 5 => array:2 [ "nombre" => "Matilde" "apellidos" => "Achaval" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222016039?idApp=UINPBA00004N" "url" => "/18075932/0000006500000012/v1_202212011539/S1807593222016039/v1_202212011539/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1807593222016015" "issn" => "18075932" "doi" => "10.1590/S1807-59322010001200015" "estado" => "S300" "fechaPublicacion" => "2010-01-01" "aid" => "1601" "copyright" => "CLINICS" "documento" => "article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/" "subdocumento" => "fla" "cita" => "Clinics. 2010;65:1315-23" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CLINICAL SCIENCE</span>" "titulo" => "Morphological and hemodynamic patterns of carotid stenosis treated by endarterectomy with patch closure versus stenting: a duplex ultrasound study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1315" "paginaFinal" => "1323" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig2" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 480 "Ancho" => 478 "Tamanyo" => 43545 ] ] "descripcion" => array:1 [ "en" => "<p id="spara30" class="elsevierStyleSimplePara elsevierViewall">Mean duplex-velocities (PSV and EDV, cm/s) through the p-ICA (a), d-ICA (b) and CCA (c) over the follow-up period.</p> <p id="spara40" class="elsevierStyleSimplePara elsevierViewall">PSV: peak systolic velocity; EDV: end diastolic velocity; p-ICA: proximal internal carotid artery; d-ICA: distal internal carotid artery; CCA: common carotid artery; CAS: carotid artery stenting; CEA: carotid endarterectomy.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marcia Maria Morales, Alexandre Anacleto, Marcello Azem Buchdid, Paulo Ricardo Baggio Simeoni, Sérgio Ledesma, Crescêncio Cêntola, João Carlos Anacleto, Marcela Aldrovani, Carlos Eli Piccinato" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Marcia Maria" "apellidos" => "Morales" ] 1 => array:2 [ "nombre" => "Alexandre" "apellidos" => "Anacleto" ] 2 => array:2 [ "nombre" => "Marcello Azem" "apellidos" => "Buchdid" ] 3 => array:2 [ "nombre" => "Paulo Ricardo Baggio" "apellidos" => "Simeoni" ] 4 => array:2 [ "nombre" => "Sérgio" "apellidos" => "Ledesma" ] 5 => array:2 [ "nombre" => "Crescêncio" "apellidos" => "Cêntola" ] 6 => array:2 [ "nombre" => "João Carlos" "apellidos" => "Anacleto" ] 7 => array:2 [ "nombre" => "Marcela" "apellidos" => "Aldrovani" ] 8 => array:2 [ "nombre" => "Carlos Eli" "apellidos" => "Piccinato" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222016015?idApp=UINPBA00004N" "url" => "/18075932/0000006500000012/v1_202212011539/S1807593222016015/v1_202212011539/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CLINICAL SCIENCE</span>" "titulo" => "Association between ear creases and peripheral arterial disease" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1325" "paginaFinal" => "1327" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Paulo Müller Ramos, Juliana Hammoud Gumieiro, Hélio Amante Miot" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Paulo Müller" "apellidos" => "Ramos" "email" => array:1 [ 0 => "dermato.paulo@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor1" ] ] ] 1 => array:2 [ "nombre" => "Juliana Hammoud" "apellidos" => "Gumieiro" ] 2 => array:2 [ "nombre" => "Hélio Amante" "apellidos" => "Miot" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "São Paulo State University – Dermatology, Botucatu, São Paulo, Brazil." "identificador" => "aff1-cln_65p1325" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Tel.: 55 14 3882 4922" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 368 "Ancho" => 423 "Tamanyo" => 29453 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Ear creases.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">Peripheral arterial disease (PAD) is a severe manifestation of atherosclerosis that may be asymptomatic or lead to critical ischemia of the lower limbs, and is also associated with increased risk of death from cardiovascular disease.<a class="elsevierStyleCrossRef" href="#bib1">1</a></p><p id="para20" class="elsevierStylePara elsevierViewall">Some known risk factors for PAD include smoking, diabetes mellitus, familial history of atherosclerotic event, hypertension, and hypercholesterolemia.<a class="elsevierStyleCrossRef" href="#bib2">2</a> The diagonal lobular crease (DLC), described by Frank,<a class="elsevierStyleCrossRef" href="#bib3">3</a> and anterior tragal crease (ATC), by Miot et al.<a class="elsevierStyleCrossRef" href="#bib4">4</a> (<a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>), were identified as factors independently associated with coronary artery disease,<a class="elsevierStyleCrossRefs" href="#bib5">5-7</a> but they have not yet been studied in patients with PAD. Detection of external signs associated with PAD can assist in risk stratification and identification of patients who would benefit from early intervention or modification of risk factors related to disease progression.</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><p id="para30" class="elsevierStylePara elsevierViewall">We studied the prevalence of ear creases in patients with PAD of the lower limbs, in comparison with patients without documented atherosclerotic disease.</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle80">METHODS</span><p id="para40" class="elsevierStylePara elsevierViewall">A cross-sectional study consisted of interviews with adult male patients treated at the University Hospital.</p><p id="para50" class="elsevierStylePara elsevierViewall">Cases were selected from claudication outpatients, with PAD of the lower limbs confirmed by arteriography. The control group was matched for gender and age and was recruited among dermatologic outpatients, who had not been revascularized (legs or ankle) or who had an ankle-brachial index not <0.9 or >1.3 (arterial noncompliance).</p><p id="para60" class="elsevierStylePara elsevierViewall">Patients who presented any of the following conditions were excluded from the study: immunosuppression, ear deformity, earring use or arterial obstruction due to other etiologies that could not be attributed to PAD.</p><p id="para70" class="elsevierStylePara elsevierViewall">The main dependent variable was the presence of PAD in the lower limbs, and the main independent variable was the presence of bilateral auricular creases. Other covariates were diabetes mellitus, previous smoking, age, familial and personal past history of atherosclerotic vascular disease (cerebral or myocardial atherosclerotic event), dyslipidemia, body mass index, and hypertension. Patients who did not know their family history were considered to have a negative history.</p><p id="para80" class="elsevierStylePara elsevierViewall">Categorical variables are given as frequencies and bivariately compared by the χ<span class="elsevierStyleSup">2</span> test or Fisher's exact test. Continuous variables are represented by mean and standard deviation and compared by the Student t-test. The association between variables is expressed as an odds ratio from the bivariate analysis subsequently adjusted by conditional logistic regression, comprising covariates with p<0.2.</p><p id="para90" class="elsevierStylePara elsevierViewall">Data were analyzed by the software SPSS 17.0. Two-tailed p values <0.05 were considered significant.</p><p id="para100" class="elsevierStylePara elsevierViewall">Sample size was defined according to the final multiple logistic model with α = 0.05 and power  =  85%.<a class="elsevierStyleCrossRef" href="#bib8">8</a></p><p id="para110" class="elsevierStylePara elsevierViewall">This study was approved by the institutional ethics committee.</p></span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle90">RESULTS</span><p id="para120" class="elsevierStylePara elsevierViewall">Sixty patients with PAD and 60 controls were enrolled in the study. The main clinical and demographic characteristics of patients and controls are listed in <a class="elsevierStyleCrossRef" href="#tbl1">Table 1</a>. The bivariate analysis disclosed the higher frequencies of known PAD risk factors among patients and also identified their positive association with ear creases. DLC and ATC were also more prevalent among cases than controls in all age groups (data not shown).</p><elsevierMultimedia ident="tbl1"></elsevierMultimedia><p id="para130" class="elsevierStylePara elsevierViewall">Multivariate analysis of the frequency of ear creases adjusted for age, diabetes mellitus, hypertension, myocardial infarction, dyslipidemia, and tobacco reinforced the association between PAD and ear creases (<a class="elsevierStyleCrossRef" href="#tbl2">Table 2</a>).</p><elsevierMultimedia ident="tbl2"></elsevierMultimedia></span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle100">DISCUSSION</span><p id="para140" class="elsevierStylePara elsevierViewall">Earlobe creases were more common in male patients with PAD than in age-matched controls. These creases may represent an external sign of microangiopathic lesions in terminal circulation of the ear that occur at the same time as PAD since atherosclerosis is a systemic disease. In other series of patients, overall mortality and sudden death were significantly higher in the group with DLC.<a class="elsevierStyleCrossRefs" href="#bib9">9,10</a> Male patients were selected to minimize the effect that earrings might have had on the ears, and because men are more affected by PAD and atherosclerosis than women. As the prevalence of both PAD and bilateral ear lobe creases increases over time, age matching was performed to normalize these risks between the groups.</p><p id="para150" class="elsevierStylePara elsevierViewall">Controls did not undergo arteriography for ethical and logistic reasons. The ankle-brachial index was chosen as the method to select controls owing to its high specificity (99%) and sensitivity (89%) for identification of PAD.<a class="elsevierStyleCrossRef" href="#bib11">11</a> Moreover, the accidental inclusion of cases among controls would have diluted the association of ear creases and atherosclerosis, rather than strengthened it.</p><p id="para160" class="elsevierStylePara elsevierViewall">The noninvasive identification of external findings, including DLC and ATC, digital clubbing, cyanosis, and hair loss on extremities provides information additional to epidemiological aspects such as smoking, hypertension, diabetes and dyslipidemia in raising a suspicion of atherosclerosis and risk of cardiovascular events.<a class="elsevierStyleCrossRef" href="#bib12">12</a></p><p id="para170" class="elsevierStylePara elsevierViewall">Further investigations should be performed with larger samples, heterogeneously distributed according to age, gender, ethnicity, and PAD severity, to provide a stratified risk analysis and a long-term follow up evaluation of prognostic factors in PAD.</p><p id="para180" class="elsevierStylePara elsevierViewall">Bilateral DLC and ATC are semiological findings which are quick and easy to evaluate and were independently associated with PAD in this population.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "xpalclavsec1582586" "titulo" => "KEYWORDS" ] 1 => array:2 [ "identificador" => "cesec10" "titulo" => "INTRODUCTION" ] 2 => array:2 [ "identificador" => "cesec20" "titulo" => "METHODS" ] 3 => array:2 [ "identificador" => "cesec30" "titulo" => "RESULTS" ] 4 => array:2 [ "identificador" => "cesec40" "titulo" => "DISCUSSION" ] 5 => array:1 [ "titulo" => "REFERENCES" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-07-15" "fechaAceptado" => "2010-09-29" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "KEYWORDS" "identificador" => "xpalclavsec1582586" "palabras" => array:5 [ 0 => "Ear" 1 => "Atherosclerosis" 2 => "Peripheral" 3 => "Arterial" 4 => "Disease" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">INTRODUCTION:</span><p id="spara60" class="elsevierStyleSimplePara elsevierViewall">Peripheral arterial disease is a severe manifestation of atherosclerosis that can lead to critical ischemia of the lower limbs and is also associated with high cardiovascular risk. Diagonal lobular and anterior tragal ear creases have been associated with coronary artery disease, but they have not yet been investigated in patients with peripheral arterial disease.</p></span> <span id="ceabs20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">OBJECTIVES:</span><p id="spara70" class="elsevierStyleSimplePara elsevierViewall">To evaluate the prevalence of ear creases among patients with peripheral arterial disease of the lower limbs, compared with patients without documented atherosclerotic disease.</p></span> <span id="ceabs30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">METHODS:</span><p id="spara80" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional study including 60 male patients with peripheral arterial disease of the lower limbs and 60 dermatologic outpatients matched for age and gender. The associations were adjusted for other risk factors by conditional logistic regression.</p></span> <span id="ceabs40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">RESULTS:</span><p id="spara90" class="elsevierStyleSimplePara elsevierViewall">The prevalence of diagonal and anterior tragal ear creases was higher among cases (73% vs. 25% and 80% vs. 43%, respectively) than controls; these associations remained significant even when adjusting for other known risk factors of atherosclerosis (odds ratio  =  8.1 and 4.1, respectively).</p></span> <span id="ceabs50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle50">CONCLUSIONS:</span><p id="spara100" class="elsevierStyleSimplePara elsevierViewall">Ear creases are independently associated with peripheral arterial disease and may be an external marker for risk identification.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "ceabs10" "titulo" => "INTRODUCTION:" ] 1 => array:2 [ "identificador" => "ceabs20" "titulo" => "OBJECTIVES:" ] 2 => array:2 [ "identificador" => "ceabs30" "titulo" => "METHODS:" ] 3 => array:2 [ "identificador" => "ceabs40" "titulo" => "RESULTS:" ] 4 => array:2 [ "identificador" => "ceabs50" "titulo" => "CONCLUSIONS:" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 368 "Ancho" => 423 "Tamanyo" => 29453 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Ear creases.</p>" ] ] 1 => array:7 [ "identificador" => "tbl1" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spara30" class="elsevierStyleSimplePara elsevierViewall">Results are shown as number (%) unless stated otherwise.</p><p id="spara40" class="elsevierStyleSimplePara elsevierViewall">Significant results are shown in bold.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Variables \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Cases \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Controls \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Odds ratio<a class="elsevierStyleCrossRef" href="#tfn6-cln_65p1325">¶</a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">p Values \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age, mean (SD)<a class="elsevierStyleCrossRef" href="#tfn3-cln_65p1325">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">66.0 (11.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">64.2 (13.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI, mean (SD)<a class="elsevierStyleCrossRef" href="#tfn4-cln_65p1325">†</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">25.1 (4.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">24.3 (4.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">0,23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Familial history<a class="elsevierStyleCrossRef" href="#tfn5-cln_65p1325">‡</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">21 (35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">15 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">0.23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Myocardial infarction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">12 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">3 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top"><span class="elsevierStyleBold">4.8</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top"><span class="elsevierStyleBold">0.02</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cerebral vascular accident \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">10 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">6 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">1.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">0.28 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">27 (45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">7 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top"><span class="elsevierStyleBold">6.2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top"><span class="elsevierStyleBold">0.00</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">49 (82) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">22 (37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top"><span class="elsevierStyleBold">7.7</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top"><span class="elsevierStyleBold">0.00</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">19 (32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">10 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">0.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ever a smoker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">53 (88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">40 (67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top"><span class="elsevierStyleBold">3.8</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top"><span class="elsevierStyleBold">0.00</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DLC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">44 (73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">15 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top"><span class="elsevierStyleBold">8.3</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top"><span class="elsevierStyleBold">0.00</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ATC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">48 (80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">26 (43) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top"><span class="elsevierStyleBold">5.2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top"><span class="elsevierStyleBold">0.00</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">DLC+ATC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top" style="border-bottom: 2px solid black">38 (63) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top" style="border-bottom: 2px solid black">8 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">11.2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">0.00</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] "notaPie" => array:4 [ 0 => array:3 [ "identificador" => "tfn3-cln_65p1325" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="cenpara10">Matched variable;</p>" ] 1 => array:3 [ "identificador" => "tfn4-cln_65p1325" "etiqueta" => "†" "nota" => "<p class="elsevierStyleNotepara" id="cenpara20">body mass index;</p>" ] 2 => array:3 [ "identificador" => "tfn5-cln_65p1325" "etiqueta" => "‡" "nota" => "<p class="elsevierStyleNotepara" id="cenpara30">familial report of cerebral or myocardial atherosclerotic event;</p>" ] 3 => array:3 [ "identificador" => "tfn6-cln_65p1325" "etiqueta" => "¶" "nota" => "<p class="elsevierStyleNotepara" id="cenpara40">unadjusted odds ratio.</p> <p class="elsevierStyleNotepara" id="cenpara50">ATC, anterior tragal crease; BMI, body mass index; DLC, diagonal lobular crease.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Main clinical and epidemiological data.</p>" ] ] 2 => array:7 [ "identificador" => "tbl2" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Odds ratio<a class="elsevierStyleCrossRef" href="#tfn8-cln_65p1325">*</a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">95% CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">p Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DLC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.8 to 23.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">0.00</span><a class="elsevierStyleCrossRef" href="#tfn9-cln_65p1325">†</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ATC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.4 to 12.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">0.01</span><a class="elsevierStyleCrossRef" href="#tfn9-cln_65p1325">†</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">DLC+ATC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">10.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">3.2 to 35.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">0.00</span><a class="elsevierStyleCrossRef" href="#tfn9-cln_65p1325">†</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tfn8-cln_65p1325" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="cenpara60">Odds ratio adjusted for age, myocardial infarction, diabetes mellitus, hypertension, dyslipidemia, and tobacco.</p>" ] 1 => array:3 [ "identificador" => "tfn9-cln_65p1325" "etiqueta" => "†" "nota" => "<p class="elsevierStyleNotepara" id="cenpara70">p (whole model) <0.01.</p> <p class="elsevierStyleNotepara" id="cenpara80">ATC, anterior tragal crease; DLC, diagonal lobular crease.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spara50" class="elsevierStyleSimplePara elsevierViewall">Multivariate analysis of auricular creases adjusted for potential confounders.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec10" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mortality over a period of 10 years in patients with peripheral arterial disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ MH Criqui \n \t\t\t\t\t\t\t\t """ 1 => """ RD Langer \n \t\t\t\t\t\t\t\t """ 2 => """ A Fronek \n \t\t\t\t\t\t\t\t """ 3 => """ HS Feigelson \n \t\t\t\t\t\t\t\t """ 4 => """ MR Klauber \n \t\t\t\t\t\t\t\t """ 5 => """ TJ McCann \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "N Engl J Med" "fecha" => "1992" "volumen" => "326" "paginaInicial" => "6" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://doi.org/10.1056/NEJM199202063260605" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999-2000" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ E Selvin \n \t\t\t\t\t\t\t\t """ 1 => """ TP Erlinger \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 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| Year/Month | Html | Total | |
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