Aim. The objective of the present study was to elucidate the metabolic role of thrombophilia as a risk factor of acute deep vein thrombosis of the lower extremities. Material and methods. The study included 80 patients with acute deep vein thrombosis (DVT) of the lower extremities aged between 25 and 59 (mean 48.3±1.5) years; 38 of them were men and 42 women. The control group was comprised of 580 subjects (360 men and 220 women) at the mean age of 49.9±0,5 years showing no signs of venous pathology and selected from the population-based samples of the residents of two administrative districts of Novosibirsk. We estimated the prevalence of metabolic syndrome (MS) and its components according to the criteria of ВНОК and IDF; molecular-genetic studies were carried out to reveal the presence of clinically significant SNPS in the hemostatic system, namely FV Leiden (А506G), polymorphism in the prothrombin gene (G20210A), of MTHFR (С667Т) deficit of the homozygous or heterozygous type. Results. The prevalence of metabolic syndrome in  the study group according to the IDF criteria was 53.8% (47.4 per cent among men and 56.8% among women), and that in accordance with the criteria of ВНОК 41.3% (34,2 and 45.5% respectively). In the control group, the prevalence of MS according to the IDF criteria was 28.8% (26.3% in men and 20.0% among women), and according to the criteria of ВНОК 25.0% (37,2 and 17.5%, respectively); p<0.05. Hypertriglyceridemia was detected in 76.2% of the patients with acute DVT compared with 22.2% in the control group. The difference in the frequency of hypertriglyceridemia between the two groups was statistically significant (p<0.001). An increased LPDL-cholesterol level (>3.0 mmol/l) was observed in 47.4 per cent of the patients with DVT. In the control group, the LDL-cholesterol level in plasma higher than 3.0 mmol/l was found in 26.7% of the patients; the difference was significant (p<0.05). The reduction of the LHDL-cholesterol level down to  <1.0 mmol/l in men and to <1.2 mmol/l in women according to the criteria of  ВНОК and IDF was documented in 43.7% of the patients in the study group. In the control group, such patients made up 10.0% (n=58) including 13 (5,9%) men and 45 (12,4%) women respectively. The difference was significant at p<0.05. We did not find a statistically significant difference in the incidence of FV Leiden (А506G) and SNP mutations in the prothrombin gene (G20210A) in the overwhelming majority of the subjects in the study and control groups. The significant difference (p<0.001) between the study and control groups was documented in the incidence of SNP ST gene of MTHFR due to a significant increase in the proportion of carriers of the TT genotype in the group of patients with acute deep vein thrombosis in the lower extremities. Conclusion. Polymorphism of С667T gene of MTHFR and MS is the  risk factor of deep vein thrombosis in the lower extremities. The results of the present study provide a basis for the recommendation to complement the existing schemes for diagnostics of thrombophilia by the identification of the polymorphism of the С667T gene for MTHFR and metabolic disorders.