A 67-year-old smoker is brought to the ER with severe abdominal pain and hypotension. He has a h/o hypeension, asthma and type-2 DM. He currently takes Lisinopril and Metformin. O/E- HR: 100 bpm, BP is 100/60mmHg, S1 & S2- normal, chest- clear. Which of the following risk factors is most likely to have contributed to the development of his underlying condition?