The underlying cause of aneurysmal aortic dilation is uncertain in most patients. It is unclear whether atherosclerosis causes aneurysmal disease or vice versa, while familial clusters are suggestive of a possible genetic predisposition. The data obtained from well-designed molecular and clinical studies support a multifactorial, systemic, nonatherosclerotic causal hypothesis, such as a defect in vascular structural proteins, with atherosclerosis occurring as a secondary process.
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