PCSK9 and achalasia-alacrima syndrome: Putative associations between PCSK9 variants or polygenetic lipid variant risk scores and AAA disease may be confounded by common risk factors for atherosclerosis and AAAs [46], or alterations in aortic inflammation, stiffness or structural features such as vascular-associated lymphoid tissues secondary to co-existing atherosclerosis may also link cholesterol to AAA risk [22,23,24,25,26,47,48,49].