This segment of the aerial intima of a coronary vessel is observed at autopsy in a 56-year old man who died suddenly on rising in the morning. Which of the following abnormalities is considered a major risk factor for the development of this lesion?

The figure shows an organised atheromatous plaque occluding the vascular lumen. The slit-like spaces in the middle are cholesterol clefts surrounded by fibroblasts. The clinical scenario strongly suggests that this affected vessel is a coronary aery. Cleft-like spaces indicating the presence of cholesterol crystals are very prominent and help in the identification of the lesion. The incidence of atherosclerosis is strongly associated with hypercholesterolemia. Principal components of atheromatous plaque: smooth muscle cells, macrophages ,and T cells. Extracellular matrix, including collagen, elastic fibre and proteoglycans intracellular and extracellular lipid. Calcification in later stages