Object of the study: coronary disease (CD): stable and unstable angina. Purpose of the study: the optimization of therapeutic approaches to the correction of the clinical state and disturbances in the lipid metabolism and vasoactive endothelial factor composition in patients with stable and unstable angina in the conditions of atherogenic dyslipoproteinaemiae (DLP) on the basis of the analysis of the clinical course of the disease, lipid metabolism and plasma concentrations of vasoactive endothelial factors, their relationships and dynamics under the effect of complex therapy with use of Symvastatin and its combination with therapeutic discrete plasma exchange. Methods of the investigation: general clinical, laboratory (clinical, biochemical, enzymoimmunoassay, immunoenzymometric assay), statistical methods. Theoretical and practical results: in order to optimize the treatment of patients having stable and unstable angina of functional classes (FC) III and IV with atherogenic DLP, it is recommended that their complex therapy should include the method of discrete plasma exchange, which is performed four times, once every 3 weeks, with an extraction of 600-650 ml of plasma during one procedure. To improve the quality of diagnosis of the unstable angina syndrome in patients with normolipidaemia (NLP), the necessity of detecting the blood level of apolipoproteins (Apo) A-1 and B and their proportion was grounded. It is suggested to use an increased Apo B/Apo A-1 proportion of more than 1.15 as an additional criterion for diagnosing a destabilized course of angina. In order to assess the dynamics in the state of patients having unstable and stable angina of FC III and IV with NLP and DLP, it is recommended that plans of their dynamic examination should include the detection of Apo B/Apo A-1 proportion, whose elevation is of pathogenetic significance in the development of endothelial dysfunction, which increases, if lipid metabolic disturbances and the clinical syndrome of angina progress. Novelty: on the basisof the analysis of clinical and laboratory studies, peculiarities were revealed in the functional state of the endothelium in patients having unstable and stable angina of FC III and IV with IIa, IIb and IV types of DLP and in conditions of NLP. More expressed disruptions in the endothelial function in patients with IIa and IIb types of DLP, as well as a destabilized course of angina, were found out. It was revealed that the endothelial dysfunction in patients with unstable and stable angina of FC III and IV was associated with a violation in the proportion of the basic Apo. Reliable correlations of ET-1 and 6-keto-PGF1a levels with the value of Apo B/Apo A-1 proportion were found out in patients with stable and unstable angina in both DLP and the conditions of NLP. For the first time, it was demonstrated that, in patients with NLP, the value of Apo B/Apo A-1 proportion exceeding 1.15 was a lipid marker of destabilization of the clinical course of angina. A comparative assessment is given for the clinical andhypolipidaemic efficacy, as well as the effect, produced on blood concentration levels of vasoactive endothelial factors, by a 30-day course of complex therapy with use of Symvastatin and its combination with the method of therapeutic discrete plasma exchange in atherogenic DLP in patients having different clinical forms of CD. Degree of introduction: results of the research were introduced into the practical work of departments of the Kharkiv Regional Students’ Hospital, Kharkiv City Multi-Type Hospital No. 17, Family Doctor Outpatient Department of Internationalist Youth Housing Cooperative Society, as it is confirmed by corresponding acts on introduction. Sphere of application: medicine, cardiology.
