Which factor contributes to the increased cardiovascular risk in the described patient with diabetes and smoking?

• A. High fruit intake
• B. Regular exercise
• C. Low body weight
• D. Diabetes

Answer: (D)

Diabetes itself greatly raises cardiovascular risk because chronic high blood glucose drives vascular damage and a cluster of metabolic abnormalities. In diabetes, there’s typically dyslipidemia (high triglycerides, low HDL), hypertension, inflammation, and endothelial dysfunction, all of which promote atherosclerosis. Smoking adds another layer by increasing oxidative stress, promoting platelet activation, and causing vasoconstriction—further accelerating plaque formation and rupture. When both diabetes and smoking are present, their effects on cardiovascular risk are synergistic, making diabetes the key factor contributing to the increased risk in this patient. High fruit intake and regular exercise are protective, while low body weight also tends to reduce risk, so they do not explain the elevated risk here.