Current Former Never

If Former, How long ago did patient quit smoking?

Unknown <6 months ago 6 months-1.5 years ago >1.5-2.5 years ago >2.5-3.5 years ago >3.5-5 years ago >5 years ago

Less than 1 yr 1 to <5 yrs 5 to <10 yrs 10 to <15 yrs 15 to <20 yrs ≥20 yrs

Yes No

If Yes, Years since diagnosis:

Less than 1 yr 1 to <5 yrs 5 to <10 yrs 10 to <15 yrs 15 to <20 yrs ≥20 yrs

If Yes, whether taking antihypertensive drugs:

Yes No

Yes No

If Yes, Years since diagnosis

Less than 1 yr 1 to <5 yrs 5 to <10 yrs 10 to <15 yrs 15 to <20 yrs ≥20 yrs

If Yes, whether taking lipid lowering drugs:

Yes No

Yes No

If Yes, Years since diagnosis:

Less than 1 yr 1 to < 5 yrs 5 to < 10 yrs 10 to < 15 yrs 15 to < 20 yrs ≥20 yrs

Yes No

If No, specify the reason;

If Yes, duration of therapy;

Yes No

If Yes, History of Myocardial Infarction (MI):

Yes No

If Yes, Coronary Intervention done:

Yes No

If Yes, Type of Intervention:

Coronary Angioplasty Coronary artery bypass graft (CABG)

Yes No

If Yes, Years since diagnosis:

Less than 1 yr 1 to < 5 yrs 5 to < 10 yrs 10 to < 15 yrs 15 to < 20 yrs ≥20 yrs

Yes No

If Yes, Years since diagnosis:

Less than 1 yr 1 to <5 yrs 5 to <10 yrs 10 to <15 yrs 15 to <20 yrs ≥20 yrs