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A 72-year-old man comes to the emergency department due to severe chest tightness and dyspnea that started 20 minutes ago at a family dinner. He has never experienced similar symptoms before. The patient's medical conditions include hypertension, hyperlipidemia, type 2 diabetes mellitus, and prostate cancer. He takes multiple medications and has no drug allergies. The patient smoked a pack of cigarettes daily for 30 years and stopped smoking 10 years ago. Chest CT scan with contrast is shown in the image below. Which of the following factors most likely contributed to this patient's current condition?
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