The scientific work is devoted to working off the scheme of diagnostic evaluation and management of the patients with verified atherosclerosis of coronary arteries on the basis of clinical, anamnesis and genetic factors which influence occurrence of atherosclerotic lesion. It is demonstrated, that in patients with a verified atherosclerosis of coronary arteries process has systemic character in 71,6 % of cases with involving the carotid and peripheral arteries of lower extremities. It is proved, that signs of instability of atherosclerotic lesion in one of the vascular regions are combined in 61,4 % of cases with presence of similar morphologic changes in others. At the analysis of a role of traditional risk factors for development of multi-vascular atherosclerotic process by means of the multifactorial analysis the following ranging risk factors established: a level of systolic arterial pressure (3), atherosclerotic complications in history (3), male sex (2), type 2 diabetes mellitus (3), smoking (2), overweight (2), dislipoproteinemia (2), and heredity (1). Analysis of a role which the investigated factors play in the prevalence of the atherosclerotic lesion showed, that deletion polymorphism of a angiotensin-converting enzyme (ACE) gene and activity of this enzyme more than 57,5 U/L are associated with the development of systemic atherosclerotic lesion. Among patients with system type of atherosclerosis deletion polymorphism was registered in 81,2 % and the ACE activity was in the range from 67,9 up to 87,5 U/L, while in mono-region vascular lesion group enzyme activity did not exceed 64,2 U/L. Presence of deletions in ACE genotype and elevated level of ACE are associated with "unstable" course of atherosclerotic process. In patients with unstable lesions, as to the data of coronary angiography and Doppler ultrasonography, deletion polymorphism was established in 89,1 %, and the average level of angiotensin-converting enzyme activity was 67,9±4,6 U/L. No significant differences were found in the level of enzyme activity depending on localization of unstable lesion. Observation of patients for the period of 16±2,7 months showed the high level of cardiovascular death rate within one year - 6,8 %. Multifactorial analysis of factors influencing the frequency of endpoints in the given category of patients showed the greatest negative prognostic significance of the following: presence of unstable atherosclerotic lesion in any vascular region, atherosclerotic complications in history, involving of several vascular regions, hypertension, type 2 diabetes mellitus, heredity, level of ACE greater than 57,5 U/L, deletion polymorphism of ACE gene.
