Studies on selected cardiac patients have supported the association between diagonal ear-lobe crease (ELC) sign and coronary artery disease (CAD). The aim of this study was to assess the value of this sign as a predictor of the presence of CAD in the non-cardiac patient population, to see if any association exists between the two and to compare any association with other established risk factors. A significant association exists between ELC and a history of CAD, which is not solely attributable to the increased prevalence of the sign with increasing age. A higher correlation was found between CAD and ELC than between CAD and other risk factors. The sensitivity of the sign was 48%, the specificity 88%, and the positive predictive value 16%. In this population the finding of an ELC is of little clinical value.