Visible age-related signs in an Arab patient presenting with a myocardial infarction.

A 45-year-old Arab woman presented with acute ST-elevation myocardial infarction in the absence of any traditional cardiovascular risk factors (CVRF). It was noted she appeared ‘older than she looked’ with premature cutaneous signs of ageing, including significant wrinkling, bilateral xanthelasma palpebrarum (Fig. 1A), bilateral diagonal ear lobe creases (Frank’s sign) (Fig. 1B and C) and fronto-temporal hairline recession with associated greying hair. Recent evidence from longitudinal studies suggest a significantly higher risk of ischemic heart disease (IHD) with any of these features, and a stepwise increase in incidence with the presence of multiple features, independent of traditional CVRF [1]. However, these studies were performed on a purely white Danish ancestral population with results not immediately applicable to other ethnic groups. We believe this is the first reported case of a non-white patient presenting with index IHD without traditional CVRF but with multiple features of premature ageing, lending support to these recent results. With the rising tide of cardiovascular disease in the Arab community, [2,3] any sign that can lead to earlier intervention is worth considering. Whilst there is no formal guideline, physicians should keep vigil and consider early cardiovascular consultation if these signs are present. Further multinational cross-sectional studies are warranted.

Figure 1

(A) Bilateral xanthelasma palpebrarum; ear lobe crease (Frank’s sign) on the right (B) and left (C) ears. Main – photograph of patient showing greying hair, wrinkled forehead and globally receding hairline.