Review Question - QID 210891

A 75-year-old Caucasian man presents to the emergency department with abdominal pain. He was at home eating dinner when he began to experience severe abdominal pain. The patient has a medical history of diabetes, hypertension, and atherosclerosis. He lives at home alone, smokes cigarettes, and drinks 1 to 2 alcoholic drinks per day. His temperature is 98.7°F (37°C), blood pressure is 153/95 mmHg, pulse is 70/min, respirations are 15/min, and oxygen saturation is 99% on room air. The patient is given IV morphine and an ultrasound is obtained demonstrating a dilated abdominal aorta. The patient states that his father died of a similar finding and is concerned about his prognosis. Which of the following is the greatest risk factor for this patient's presentation?