Thanks for writing in. I am a qualified and certified cardiologist. I read your mail with diligence. I am afraid you have answered your query within the question. You have enumerated some risk factors which prevents me from giving a very good prognosis. To have good prognosis, he has to STOP SMOKING
and do aerobic exercises
and do suitable exercises like brisk walking depending on his effort tolerance. I am sure, not doing these things have led to his return for invasive treatment. Good Luck. He can take suitable precautions and yet be proud of this fact also.
Dr Anil Grover