Coronary Artery Disease USMLE Step 1 Practice Question

A 42-year-old woman presents for routine health maintenance. She reports no current symptoms and denies chest pain, dyspnea, or claudication. She works as an accountant and exercises once weekly. Vital signs: BP 134/85 mmHg, HR 76/min, RR 14/min, temperature 37.2°C. Height 170 cm, weight 88 kg (BMI 30.4 kg/m²). Laboratory studies: fasting glucose 108 mg/dL, total cholesterol 220 mg/dL, HDL 38 mg/dL, LDL 145 mg/dL, triglycerides 195 mg/dL, TSH 2.3 mIU/L (normal), urinalysis normal. Physical examination reveals no xanthomas, arcus cornealis, or peripheral bruits. Which of the following long-term vascular complications is this patient at highest risk of developing?