A nurse is giving a presentation to a community group about preventing atherosclerosis. Which of the following should the nurse include as a modifiable risk factor for this disorder? (Select all that apply.)

Choice A rationale High levels of low-density lipoprotein cholesterol contribute significantly to the formation of fatty streaks in the arterial intima. This process involves the oxidation of lipids, which triggers an inflammatory response and the subsequent migration of macrophages. Because cholesterol levels can be managed through dietary modifications, exercise, and pharmacological interventions like statins, it is classified as a modifiable risk factor. Lowering total cholesterol to less than 200 mg/dL is a primary goal in preventing plaque buildup. Choice B rationale Excess body fat, particularly visceral adiposity, is linked to systemic inflammation and metabolic changes that accelerate arterial damage. It often coexists with insulin resistance and dyslipidemia, which further promote the development of atherosclerotic plaques. Weight loss through lifestyle changes reduces the mechanical and metabolic strain on the cardiovascular system. Since individuals can influence their body mass index through behavior, it is a key modifiable factor in reducing long-term cardiovascular disease risk and improving vessel health. Choice C rationale Tobacco use introduces carbon monoxide and nicotine into the bloodstream, causing direct endothelial injury and vasoconstriction. This damage allows lipids to penetrate the arterial wall more easily while also increasing platelet aggregation and fibrinogen levels. Smoking cessation significantly reduces these risks over time, allowing the endothelium to recover and slowing the progression of existing plaques. Because the behavior can be stopped, it remains one of the most critical modifiable risk factors for preventing heart disease. Choice D rationale Inherited traits and family history significantly influence an individual's baseline risk for developing cardiovascular issues at an early age. While genetic factors dictate how a person metabolizes lipids or their predisposition to hypertension, these underlying DNA sequences cannot be altered by lifestyle or medical intervention. Therefore, this is a non-modifiable risk factor. Nurses focus on managing the modifiable factors more aggressively in clients who have a strong genetic predisposition to balance out the inherent risk. Choice E rationale Chronic high blood pressure exerts constant mechanical stress on the arterial walls, leading to endothelial dysfunction and thickening. This pressure facilitates the entry of cholesterol into the subendothelial space, accelerating plaque formation and narrowing the lumen. Normal blood pressure is typically defined as less than 120/80 mmHg. Through sodium restriction, stress management, and antihypertensive medications, blood pressure can be controlled, making it a major modifiable risk factor that helps preserve the integrity of the vasculature.