A 59-Year-Old Man Visits the Office for a Check-Up

A 59-year-old man visits the office for a check-up. A month ago, the patient suffered an acute myocardial infarction, and a drug-eluting stent was effectively implanted. He has no indications of cardiovascular disease, but he does have hypertension and hyperlipidemia, as well as a 40-pack-year smoking history. The blood pressure is 132/86 mm Hg, and the pulse rate is 68 beats per minute. 30.8 kg/m² is the BMI. The physical exam is ordinary. The patient declares, "I can't wait to get back to work, but I'm worried about having another heart attack. I have a demanding work, yet I need to find time to exercise. In addition, I know I should quit smoking and drop at least 20 pounds." Which of the following is the physician's most suitable reaction at this time?

A) "Having a heart attack was frightening.  It's great that you've decided to stop smoking, lose weight, and start exercising."
B) "I suggest we prioritize quitting smoking first.  That will decrease your risk significantly and make it easier to exercise."
C) "Those are excellent goals.  Let's make a comprehensive list of all the health changes you want to make."
D) "You've been through a tough time.  Would you consider working fewer hours for the time being so you can focus on your health?"
E) "You've brought up important issues.  What are one or two small changes you feel most ready to tackle now?"