A 70-year-old woman presents with heavy, crushing chest pain…
Questions
A 70-yeаr-оld wоmаn presents with heаvy, crushing chest pain оf 3-hour duration. The pain is exacerbated with exertion and resolves with rest. Past medical history is significant for type 2 diabetes. She has a 40-year history of smoking (2 packs per week). Current medications are metformin and canaglifozin (SGLT2 inhibitor) for management of her diabetes. Physical examination reveals an overweight individual with blood pressure 145/92 mm/Hg. The remainder of the examination is within normal limits. Laboratory studies are significant for severely depressed circulating HDL, increased total cholesterol and LDL, and mildly elevated triglycerides. ECG reveals T wave inversion, and serum Troponin is within the reference range. A full workup confirms a diagnosis of acute coronary syndrome. 11. Which of the following is the strongest risk factor for this patient’s illness?