Which of the following is a major risk factor that modifies LDL goals?

• A. Cigarette smoking
• B. Low BMI
• C. Age 20-30
• D. Excessive exercise

Answer: (A)

Cigarette smoking is a major risk factor that makes cardiovascular risk higher, so LDL-C targets are set more stringent in someone who smokes. Smoking accelerates atherosclerosis through mechanisms like increased oxidative stress, inflammation, and endothelial dysfunction, meaning lowering LDL cholesterol more aggressively can help reduce the overall risk. The other options don’t raise risk in the same way: a lower BMI usually indicates lower risk, being young (20–30) is associated with lower baseline risk, and excessive exercise is protective rather than a factor that would require a tougher LDL target.