A 67-year-old man had a medical history of type 2 diabetes mellitus, dyslipidemia, hypertension, and alcohol-related liver disease. His vital signs were normal, and he had no symptoms. On physical examination, he had bilateral diagonal earlobe creases running backward from the tragus at a 45⁰ angle across the lobule to the rear edge of the auricle (Fig. 1). What is the clinical significance of this sign?
