A 52-year-old man presents with sudden crushing chest pain and tachycardia. He admits to cigarette smoking, consumption of alcohol, and abuse of illicit drugs. An ECG is consistent with ischemic change in the anteroseptal region of the heart. Laboratory studies show elevated serum levels of CK-MB and troponin I. Serum cholesterol is 240 mg/dL. Which of the following most likely contributed to this patient's condition?

Cigarette smoking is recognized as a major independent risk factor for myocardial infarction and acts synergistically with other risk factors such as high blood pressure and elevated blood cholesterol levels. It not only serves to precipitate initial myocardial infarction but also increases the risk for second heart attacks and diminishes survival after a heart attack among those who continue to smoke. Smoking also increases the incidence of sudden cardiac death, possibly by exacerbating regional ischemia. Atherosclerosis of the coronary arteries and the aorta is more severe and extensive among cigarette smokers than among nonsmokers, and the effect is dose related. Chronic alcohol consumption (choice A) actually protects against coronary artery disease, although dilated cardiomyopathy may develop. The other choices are not related to heart disease.Diagnosis: Myocardial infarction