Fourth, the coronary arteries, carotid bifurcation and aorta are vascular beds in which atherosclerosis is dominant, but in the femoral artery also medial arterial calcifications occur.19,20 In PXE patients, calcification of elastin fibers in the medial arterial wall occur which is different from atherosclerosis which is characterized by calcification of the intimal layer.21 Therefore, the results in PXE patients might not be generalizable to the atherosclerosis in general. Here, ELN is linked to atherosclerosis.