Strengths and limitations
Limitations of the current study are the lack of clinical data, especially cardiac data, including aortic size, in these women. Since this is a register study we cannot comment on the impact of clinical surveillance or of medical intervention, such as for example the use of beta blockers or ACE-inhibitors. Strengths of this study are the inclusion of diagnosed as well as undiagnosed women with Marfan syndrome and the nationwide approach with including all diagnosed Marfan syndrome women. Further, the possibility to utilize the registers with cross-linkage, which enable identification of the age-matched controls and the linkage to all hospital contacts, is of paramount importance.