Identifying High-Risk Factors for Heart Disease

A 50-year-old male patient presents for a routine health screening. He has a family history of cardiovascular disease, with his father having a myocardial infarction at age 55. The patient smokes one pack of cigarettes daily, has a sedentary lifestyle, and his current BMI is 28. He states that he occasionally consumes alcohol, but he is unsure of the amount. Which of the following risk factors places this patient at the highest risk for developing heart disease?