The aim of the research was to study the prevalence of insertion-deletion polymorphism variants of the angiotensin-converting enzyme (ACE) gene in patients with established coronary artery disease (CAD) and hemodynamically significant atherosclerosis of coronary arteries (CA) according to selective coronary ventriculography (SKVG), and the association of this polymorphism to clinical manifestations of the disease. The study involved 318 patients with CAD (males only) in which during SKVG hemodynamically significant CA stenoses have been revealed. Control group consisted of 35 individuals with negative result of the exercise test and no morphological changes during SKVG. Evaluation of patients included determination of the glomerular filtration rate (GFR), ankle-brachial index (ABI), Doppler ultrasound of the lower extremities vessels (LEV) and carotid artery, with thickness of the intima-media (TIM) estimation. Investigation of insertion-deletion polymorphism of the ACE gene was performed by polymerase chain reaction. The distribution of I/I, I/D, and D/D genotypes in the group of patients with CAD was 24.5; 47.5 and 28 %, while in the control group – 40.0; 42.9 and 17.1 %, respectively. Surveyed patients were divided into three groups: I group – 78 patients with I/I; II group – 151 patients with the I/D, III – 89 with D/D genotypes. It was found that in groups II and III arterial hypertension (AH) occurs significantly more often, age of hypertension onset was significantly less than that in the I group (Р<0.05). CAD occurred at younger age in patients of II and III groups and clinical manifestations of CAD before myocardial infarction were registered more often than in patients of the I group (Р<0.05). The TIM value in group III was significantly greater, and ABI – significantly lower than in I group (Р<0.05). According to the SKVG results, hemodynamically significant lesion of three CA, as well as the diffuse type of damage for patients of II and III groups occurred significantly more often than in the I group (Р<0.05). In conclusion, the presence of the ACE gene mutant D allele in patients with CAD is associated with earlier manifestation of CAD and AH, decreased GFR, multivessel and diffuse atherosclerotic lesion.