Q. A 57-year-old African American woman visits the primary health care clinic for routine follow-up. The patient currently has no complaints except for knee pain. Her past medical history is significant for diabetes, hypertension, dyslipidemia, and osteoarthritis. Her current medications include metformin, ramipril, atorvastatin, and ibuprofen. She has smoked 30 cigarettes/day since her divorce ten years ago. The patient's vital signs are blood pressure 151/93 mm Hg, heart rate 80/min, respiratory rate 12/min, and temperature of 36.9 degrees Celsius. On physical examination, a pulsatile mass is noted in her epigastric region. Abdominal ultrasound confirms the diagnosis. Regarding the above patient, which of the following is considered a major risk factor for her new diagnosis?