Hipergomocystenemia (HHC) is a significant risk factor for cardiovascular deseases. According to research in HHC incidence of acute myocardial infarction (AMI) increases by 3-4 times. There are hereditary and acquired causes of HHC. One of the reasons is the presence of inherited genetic polymorphisms in the MTHFR gene. According to research conducted by us, the level of homocysteine (HC) plasma at the time of admission was higher than the reference values in 75 % of cases (95 % CI: 60-86). On the 14th day of flow above the AMI level of HC reference values was observed in 73 % (95 % CI: 57-84) cases. The level of HC in patients with homozygous MTHFR gene polymorphism was significantly higher than in patients with heterozygous polymorphism, or without it on the first day of flow of AMI (p = 0.028), and on the 14th day course of acute myocardial infarction (p = 0.001.) In assessment of the long-term outcome after coronary flow AMI endpoints (development of re-infarction, unstable angina, stroke, repeat revascularization, death from CHD), there has been established a clear correlation between the presence of genetic polymorphisms in the MTHFR gene and the development of re-infarction (p = 0.04), the need to repeat revascularization (p = 0.003), the development of unstable angina (p = 0.001). In patients with homozygous polymorphism in the gene encoding MTHFR, re-infarction occurred more frequently (p = 0.021). These data suggest HHC, as one of the most important risk factors for AMI, as well as a higher level of HHC and more severe course of acute myocardial infarction in patients with the presence of polymorphisms in the MTHFR gene.

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Relevance. Of particular concern and anxiety among clinicians is incipience of the current unfavorable trend "rejuvenation" of the coronary heart disease (CHD). It is known that in patients under 40, incidence of acute myocardial infarction (AMI) is about 7 % of all cases reported under the age of 65 years. Younger patients are the most active members of the society. In this regard, the study of etiologic aspects, and the search for new pathogenetic mechanisms of acute myocardial infarction is an important task, which defined the purpose of our cohort study. Objective. The aim of our study was to study acute myocardial infarction etiological aspects in patients under 45. Materials and methods. In the period from 1999 till 2008, 221 patients were treated in the Emergency Care Unit with diagnosis of acute myocardial infarction under 45, what represented 8.3 % of all treated patients with AMI. 132 patients with acute myocardial infarction, residents of Arkhangelsk, were examined. We carried out a retrospective analysis of medical records to assess epidemiological components. Results. The analysis has revealed AMI in the patients under 45 years in 8.3 % of cases. Among risk factors of coronary artery disease, we observed: lipid metabolism impairments in 100 % of cases, smoking occurred in 75 % of cases. Hypertension as a risk factor was observed in 68 % of patients. The fact of physical inactivity was reported in 56 % of patients. 55 % of patients were overweight or suffered from obesity. 42 % of the observed patients had coronary artery disease in their family history. According to CAG, 98.8 % of the patients had significant coronary lesions, while 65% of patients had a multivessel disease. A statistically significant relationship F = 10.339, (ρ = 0.002) between genetic predisposition and AMI in the young patients has been revealed. This fact motivated us to conduct molecular-genetic testing of blood. As a result, we identified violent pathological polymorphisms in the hemostatic system in relation to atherosclerosis. This fact induces for further researches in this direction.