A 60-year-old mildly obese woman is admitted to the hospital with a chief complaint of recurrent chest pain on exertion. The patient reports several episodes of chest pain over the past several years and painful leg cramps when walking. Fasting blood glucose (160 mg/dL) and total serum cholesterol (370 mg/dL) are high. The ECG is normal and blood tests for cardiac-specific proteins are negative. Chest pain in this patient is most likely due to which of the following underlying conditions?

Patients with severe atherosclerosis present with organ-specific vascular disorders, including intermittent claudication, abdominal aortic aneurysms, coronary artery disease (chest pain), cerebrovascular disease, and peripheral vascular disease. Angina pectoris is the pain of myocardial ischemia. It typically occurs in the substernal portion of the chest and may radiate to the left arm, jaw, and epigastrium. It is the most common symptom of ischemic heart disease. Laboratory findings in this patient show evidence of diabetes mellitus and hyperlipidemia, which are risk factors for atherosclerosis. Thrombosis of a ruptured atheromatous plaque (choice E) usually precipitates acute myocardial infarction. The other conditions (choices C, D, and E) may limit coronary blood flow and present with chest pain on exertion, but they are less common than coronary atherosclerosis.Diagnosis: Ischemic heart disease, atherosclerosis