A 77-year-old woman sees her physician for a routine health maintenance examination. On physical examination, she is afebrile. Her pulse is 66/min, respirations 14/min, and blood pressure 125/85 mm Hg. On auscultation, a systolic ejection murmur is heard. There are a few crackles over the lung bases posteriorly. From the representative gross appearance of the aortic valve shown in the figure, which of the following most likely contributed to the development of this lesion?

• Chromosomal aneuploidy
• Aging
• Tertiary syphilis
• Atherosclerosis

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