Introduction. Among medical and social problems, obesity (Ob) occupies one of the leading places. This is related to the established pathogenetic connection of Ob with type 2 diabetes mellitus, arterial hypertension, acute vascular events, dementia, osteoarthritis, obstructive sleep apnea and some forms of cancer. Ob is also associated with social problems and reduced work capacity. Despite numerous studies on the study of Ob, a number of unresolved issues and controversial points of view remain. The aim – is to analyze the currently existing data on the heterogeneity of Ob and the main pathogenetic factors of its development based on the study of literary sources, mainly for a period of 10 years. Materials and methods – an electronic search was carried out in MEDLINE/PubMed, Google Scholar and Web of Science databases using the keywords "obesity", "obesity heterogeneity", "obesity etiopathogenesis" with subsequent analysis of literature sources published mainly in the last 10 years. The results. To date, there is no single universally accepted classification of Ob, and those currently used in clinical practice and during scientific research are based on one or another criterion. Such criteria include etiopathogenetic factors, type of adipose tissue deposition, degree of weight gain, etc. The use of bioimpedancemetry became the basis for the assertion about the heterogeneity of Ob with the selection of its separate forms, namely: metabolically healthy Ob; metabolic Ob with normal body weight, sarcopenic and metabolically unhealthy Ob. Despite the lack of clear diagnostic criteria for each of these forms, their differences in clinical course, pathogenetic factors of development and degree of cardiovascular risk have been established. Considering the indicated heterogeneity, the selection of the leading etiological factor of Ob remains a rather controversial and difficult issue. The exceptions, obviously, should include cases of the secondary form of this pathology, when Ob is one of the symptoms and is pathogenetically related to the underlying disease. In general, it is believed that, being hereditary, Ob is the result of the interaction between genetic, hormonal-metabolic, behavioral and environmental factors. Conclusions. Ob is a chronic multifactorial and heterogeneous disease, the individual clinical forms of which differ in the course and level of metabolic disorders. Etiopathogenetic factors of the development and progression of Ob are multifactorial and include genetic predisposition, factors of the external and internal environment, eating behavior and hormonal and metabolic shifts. According to the data obtained today regarding the heterogeneity of Ob and the pathogenetic mechanisms of its development, a new generally accepted characteristic and classification of this pathology should be accepted.

The disappearance of atrial tachycardia paroxysms after radiofrequency catheter ablation (RFA) of ectopic focus in a left atrium is presented on example of clinical case. Atrial tachycardia paroxysms disappeared after ablation completely. In this case, the RFA of atrial tachycardia was effective. The initial high total power of the HRV spectrum in the patient after ablation decreased by 5 times, but may predict rhythm disturbances in future. In pharmacotherapy, which included cardiomagnil and bisoprolol, the reduction in HRV suggested a gradual increase of the bisoprolol dose.

Familial combined hyperlipoproteinemia is considered one of the most common genetic hyperlipidemias in the general population with estimated prevalence 0.5 %–2.0 % of all inherited dyslipidemias. This disorder frequently coexists with other metabolic diseases such as obesity, insulin resistance, hypertension, non-alcoholic fatty liver disease. Association of hyperlipoproteinemia and type 2 diabetes mellitus can be explained due to the fact, that familial combined hyperlipoproteinemia is caused by genetic variability, including genes encoding the upstream transcription factor 1. The last regulates nearly 40 genes implicated in lipid, lipoprotein and carbohydrate metabolism, as well as immune response. Polymorphism in the upstream transcription factor 1 is strongly associated with dyslipidemia, impaired glucose tolerance, insulin resistance, and type 2 diabetes mellitus. In this report on example of clinical case we want to pay attention of practitioners to the problem of familial causes of hyperlipidemias, which leads to early onset of atherosclerosis, cardiovascular disease, and, finally, to premature disability of the affected person. Because of the frequent overlapping with the features of metabolic syndrome, this serious disorder is often not recognized and treated timely. Our patient was a 43 year old male, who was referred to the clinic with complaints of angina pain and dyspnoea provoked by minimal physical exertion, palpitations, irregular heartbeats, lower extremities and face oedema. At the age of thirty in the patient have developed type 2 diabetes mellitus, during last 7 years it was insulin dependent, the course was severe, glycaemia was poorly controlled by the therapy. Also he had essential hypertension III grade. At the age of 37 years the patient suffered from ST-elevated myocardial infarction, one year later occurred recurrent myocardial infarction. His family history was strongly positive for atherosclerosis and cardiovascular disease, as well as type 2 diabetes mellitus. In laboratory testing the fasting blood sample revealed a grossly lipemic serum, with total cholesterol level 17.75 mmol/L, very low density lipoproteins 3.41 mmol/L, low density lipoproteins 13.64 mmol/L, high density lipoproteins 0.7 mmol/L. Diagnosis: «Familial combined hyperlipoproteinemia (Fredrickson type 2B). Acute coronary syndrome: Unstable angina IIB. Postinfarction (STEMI 2014, 2015) cardiosclerosis. Essential hypertension III degree III stage. Heart failure with left ventricular systolic and diastolic dysfunction, EF 36 %. III functional class NYHA. Stage D AHA. Risk score 4 (very high).Type 2 diabetes mellitus, insulin dependent, severe course. Non-alcoholic fatty liver, 2 degree. Nodular goitre I degree, euthyroid state» was established. Management of this patient includes lifestyle modification and combined lipid lowering therapy in high doses: rosuvastatin and choline fenofibrate. Unfortunately, in this case target levels of cholesterol and triglycerides were not achieved: minimal level of total cholesterol was 12.29 mmol/L, and level of triglycerides was 41.48 mmol/L. Risk estimates based on risk charts, scores, or functions used in the general population, probably grossly underestimate the real risk of this patient with familial combined hyperlipoproteinemia. Coexistence of extremely high level of cholesterol and type 2 diabetes mellitus significantly aggravates and advances each other's course, comparing with the isolated disorders.