Second, VSMC promoters (such as SM22α) can also be expressed by myeloid cells that differentiate and accumulate in plaques.38 However, we have previously shown that the minimal SM22α promoter is not expressed in bone marrow, peripheral blood, or spleen.39 Third, SIRT6 expression in VSMCs in human plaques might be different from normal aortas due to risk factors, such as diabetes or hypertension; however, cultured VSMCs showed markedly reduced SIRT6 even when isolated from the patient. Here, SIRT6 is linked to Hypertension.