The aim of this study was to assess the fatty acid balance in the blood plasma, in the fragments of the intact vessels and the vessels showing signs of atherosclerosis.Material and Methods: The article presents the results of the examination of the blood plasma samples of patients with coronary heart disease and coronary atherosclerosis. The control group consisted of 16 healthy individuals. Also, the fragments of the abdominal aorta and the common carotid artery with varying degrees of atherosclerotic lesions were studied. Fatty acid analysis was conducted using capillary gas-liquid chromatography. Results: A reduction in the relative linoleic acid level with an increase in almost all the saturated fatty acids and polyunsaturated dihomo-γ-linolenic acid in the plasma was noted in patients with coronary heart disease and atherosclerosis. The relationships between certain fatty acids in patients with atherosclerosis and myocardial ischemia showed changes. In patients with atherosclerosis, a marked imbalance was observed between the monounsaturated and correspondingly the saturated fatty acids (with the same number of carbon atoms) in the abdominal aorta with significant atherosclerotic lesions, as well as in the intact common carotid arteries. These disorders are probably related to the relatively low content of the linoleic acid in the blood plasma. The reasons for the increased activity of the fatty acid synthase in vessels with significant atherosclerotic lesions are described. It is concluded that most of the fatty acids of the plaque were formed due to the synthetic processes in the smooth muscle cells, and not as a result of their intake from the blood plasma.