Unfortunately, it is not as atypical as one would think given the rising epidemic of diabetes. She is doing everything wrong by not quitting smoking and keeping her blood pressure under control. Just one of those combined with diabetes significantly increases her risk of cardiovascular disease. As one mentioned, both heart attack and stroke as well as peripheral arterial disease in the legs as it is all a system. Combine all three, I would say she is at an extremely high risk of an adverse cardiovascular event. I see patients in their 30 s who have had heart attacks b/c of smoking. And scores more diabetics in the 40 s and 50 s with heart attacks. Too young and preventable. Given the information of that she is already having heart related issues. She will cut 20 years off of her life. Possibly before 60 or sooner. Much higher probability before 65 It is difficult to change a person s habits though but it can be done, but difficult. The cold hard facts of where she sees at may jar some sense into her