Objective — to determine pulse wave parameters with an Angioscan-01 device and to identify endothelial dysfunction markers when studying the clinical, hemodynamic, and metabolic determinants of gender-specific vascular and neurocognitive heterogeneity, by taking into consideration the results of screening for dyslipidemia, apoptosis, and oxidative stress in multifocal atherosclerosis (MFA) in the Regional Vascular Center (Ufa). Material and methods. A technique for hierarchical analysis of categorical variables was used to divide the patients into three clusters according to a predominant vascular bed lesion and the clinical manifestations of atherosclerotic lesions of the heart, brain, and lower limb arteries confirmed by coronary angiography and Doppler ultrasound of the great arteries of the head and lower limbs. Ninety-six patients of them had MFA with predominant cardiac lesion (Cluster 1); 96 had MFA with predominant carotid artery lesions (Cluster 2); 96 had MFA with lower limb ischemia (Cluster 3). At the hospital stage, the patients underwent electrocardiography, echocardiography, and, if indicated, chest and abdominal magnetic resonance imaging and abdominal and renal ultrasonography, and, if needed, pelvic ultrasound. ET-1, vWF, protein C (PC), 8-OH-deoxyguanosine (8-OH-dG), and annexin-5 (An-5) were determined in the blood of all the examined patients with MFA by enzyme-linked immunosorbent assay, lipid profile using standard biochemical screening. Results. Different combinations and varying degrees were ascertained to be most commonly observed in the clinical manifestation of atherosclerotic cardiovascular disease (Cluster 1) mainly due to prior myocardial infarction in a history along with Stage III hypertension with an increase in pulse waveform type A and 8-OH-dG, a decrease in PC levels in males, as well as higher ET-1 and LP(α) concentrations in males and females; hemodynamically significant disorders of the great arteries of the head in the patients of Cluster 2 mainly with acute ischemic stroke, in which there was left ventricular hypertrophy with an increase in pulse waveform type A in females, and higher vascular age and stress index in males. The higher prevalence of prior stroke was associated with pronounced cognitive deficit among the patients of Cluster 2 with the lowest An-5 level and an increase in low-density lipoprotein cholesterol. The total severity of the status in patients with hemodynamic ischemia with the clinical manifestation of lower extremity vascular lesion was accompanied by a predominant increase in Functional Class 2 stable angina, Leriche syndrome with occlusion of iliac and superficial femoral arteries, the presence of insulin-independent type 2 diabetes mellitus concurrent with the higher concentration of the oxidative stress marker 8-OH-dG and hypertriglyceridemia in females. Conclusion. Registration of a pulse wave contour analysis, as well as the study of vascular markers revealed that endothelial dysfunction had an impact on gender-specific vascular and neurocognitive heterogeneity in MFA in elderly patients, which are associated with defects in programmed cell death and with increased oxidative stress and elevated lipid levels, which contribute to the progression of atherogenesis.