FS, which was also remarked in historical busts, was first defined by Sanders T. Frank in 1973 [1]. Since it has been defined, many studies have been conducted to explain its relationship with various diseases [13,14,15,16,17].

While FS is not congenital, its prevalence increases in some chronic diseases and with aging. In this research, the presence of FS in healthy and young (18–25 years old) adults was examined for the very first time in the Turkish population, to the best of our knowledge. Furthermore, the presence of a chronic disease in the first-degree relatives of the people whose FS was investigated was questioned and its association with FS was assessed.

Reviewing most of the studies on FS in the literature only in terms of sample age range, the mean age was generally around 60 years old or older [18,19,20]. In an autopsy study including 520 people, one of the groups examined people under the age of 40; however, it should be noted that FS is not detected in newborns and becomes visible with advanced age [3, 21]. In this research, the average age of the sampling was 20, and the pediatric period when FS does not exist or is quite rare, and the older age periods when it is very prevalent, or the normal anatomical structure is disrupted were not included. In this regard, it is distinguished from the literature.

In previous studies examining the presence of FS, the majority of the samples consisted of individuals with chronic diseases, especially individuals with coronary artery disease or control group individuals with a history of chronic diseases (excluding cardiac diseases) or individuals who died from different reasons regardless of disease [13, 14, 18,19,20]. In this study, on the other hand, none of the participants had any chronic disease and all were healthy individuals.

The earlobes of children and young adults are normally smooth. The prevalence of FS increases with aging [5]. Nonetheless, some studies have demonstrated that FS is substantial in indicating atherosclerosis, regardless of age [14, 22]. The prevalence of FS varies by society. In a systematic review of 13 cross-sectional studies involving various ethnic populations, mostly North American and Chinese populations, the prevalence of FS was reported to be 60.5%. This systematic review reported that the prevalence of FS was the lowest with a rate of 17% in the Japanese population and the highest in the North American population with a rate of 73% [23]. In an autopsy study including 520 individuals, the prevalence of FS was reported to be 55.0%. In the same study, this rate was close to 20% in individuals under the age of 40, whereas it was around 75% in individuals over the age of 60 [23]. In this study, on the other hand, the of FS was noted to be 14.7%. This ratio is slightly below the prevalence of FS in the literature. We believe that this is due to the fact that the individuals creating the sampling group are young adults and healthy individuals between the ages of 18–25.

In this study population, the female gender ratio (50.9%) was higher than that of males. Nevertheless, examining the distribution of FS detected by gender, it was noted to be more frequent in males with a rate of 58.4%. In most of the studies in the literature, as in this study, it has been reported that the FS rate identified is higher in males, despite it varies in different percentages (between 55 and 75%) [13, 20, 24, 25]. However, an autopsy study reported that the FS ratio was higher in females [21].

In terms of FS grading, in a study carried out on 165 individuals in the literature, it was reported that FS did not exist in 27 (16.4%) people, grade 1 was reported in 12 (7.3%) people, grade 2a was reported in 18 (10.9%) people, grade 2b was reported in 53 (32.1%) people, and grade 3 was reported in 55 (33.3%) people. This study reported on 165 deceased individuals with a mean age of 61. In the same study, the FS grading of 50 people whose average age was 63 years and above and whose cause of death was sudden cardiac death or death related to a cardiac cause was also indicated. Of these, 11 (22%) were reported to be grade 0–1 or 2a, and 39 (78%) were reported to be grade 2b or 3 [26]. In this study conducted on 853 individuals, while FS was not present in 728 (85.3%) of the participants, it was noted as grade 1 in 105 (12.4%), grade 2a in 16 (1.9%), grade 2b in 2 (0.2%), and grade 3 in 2 (0.2%). This study data and literature data differ from each other. This is because even though the sampling was large in previous studies, the mean age was mostly 60 years and older, and accompanying chronic diseases were reported; in this study, the mean age was approximately 20 (18–25) and all participants were healthy individuals.

In light of these data, the presence of FS and its advanced grade (grade 2b or 3) is probable in older people who are diagnosed with the disease or are symptomatic, and its prevalence is high. In this study, it was revealed that FS may also be observed in young individuals without any disease; however, its grade is generally low (grade 1 or 2a), indicating that preventive medicine should not be ignored in the healthy young generation.

Gasga and Phan [27], reported FS in a 66-year-old male patient with a history of MI who applied with chest pain complaint. In the meantime, it was reported that the patient’s father also had a history of MI and the presence of FS [27]. In another research, 41 male patients with a history of MI (59% had FS, 41% had no FS) and 134 first-degree relatives of the patients were examined. All relatives of 41 patients with MI who were diagnosed with cardiac pathology were reported to have FS, approximately half of parents without clinical cardiac pathology had FS, and approximately one-fourth of healthy siblings had FS [28]. In this study, 41 (32.8%) of the 125 people diagnosed with FS did not have a history of any chronic disease in their family members, whereas 84 (67.2%) had a history of at least 1 chronic disease in their family members. In the literature, family history has been investigated in elderly individuals with a history of chronic diseases with FS. The difference between this study and the literature is that whether healthy young individuals have FS, we assessed its relationship with family history, and this relationship was found to be significant.