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Considering the rate of MVP observed in our cEDS cohort and the knowledge that the mitral valve depends upon collagen for its tensile strength and that myxomatous MVP is characterized by disruption of the collagen layer with expansion of glycosaminoglycans within the middle layer of the valve [123], it is reasonable to consider MVP as a potential clue for cEDS, although the true clinical significance is so far unknown

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Acknowledgements We would like to acknowledge the assistance of the Penn State Department of Pharmacy Services, including Lisa Braccini-Barletta, Richard Sargent, and Jennifer Sauter, and the George Washington University Investigational Drug Service with the research cigarette inventory