Recently, clinical problems for arteriosclerosis have been important across the world. The number of the patients with Atherosclerotic Cardiovascular Disease (ASCVD) has been increasing, which leads to the cause of morbidity and mortality [1]. From anti-aging point of view, adequate treatment and care would be required for Cerebral Vascular Accident (CVA), Ischemic Heart Disease (IHD), and Peripheral Artery Disease (PAD) [2]. ASCVD includes broader range of related diseases, such as hypertension, diabetes, dyslipidemia, hyperuricemia and metabolic syndrome (MetS). As recent trend, prevalence between hypertension and hyperuricemia has been increasing, where their situation means common risk factors. The association among hypertension, Hyperuricemia (HUA), and all-cause mortality were studied using the data of National Health and Nutrition Examination Survey (NHANES) [3]. From the result of 32 thousand cases, those with hyperuricemia was 18.0%, and they showed twice prevalence of hypertension than non-hyperuricemia.

Some controversy has observed for the relationship between hypertension and hyperuricemia. As a recent study, hypertension was observed 39.16% (n=7931) for five years [4]. By the research in quartile method, hyperuricemia with hypertension (>stage2) showed Odds Ratio (OR) 1.78, and Systolic Diastolic Hypertension (SDH) as OR 1.53. Furthermore, the value of uric acid to HDL ratio (UHR ratio) has been in focus for predicting MetS and diabetes [5]. From 300 diabetic cases, MetS was present for 74.33%, who showed significantly higher UHR ratio. ROC analysis showed adequate UHR threshold 8.118%, sensitivity 70.32%, and specificity 55.08%, respectively. Thus, hyperuricemia has meaningful relationship with hypertension, dyslipidemia and MetS. For decades, authors and collaborators have continued clinical practice and research for diabetology and low carbohydrate diet (LCD) [6-9]. Furthermore, research area includes anti-aging, Mets, lifestyle-related disease, and psychosomatic medicine [10,11]. During our actual medical practice in primary care setting, we have experienced a 93-year-old impressive elderly female who showed hyperuricemia, hypertension, and less arteriosclerotic situation. Her general situation and related perspectives are described in this article.

History and Physicals

Current case has been a 93-year-old elderly female with hypertension, Gastroesophageal Reflux Disease (GERD) and hyperuricemia. She has been treated in authors’ hospital for more than 10 years, and always in the stable condition. Her lifestyle has shown almost regular situations as meal, exercise, sleeping. She has been growing flowers and vegetables in her home garden all year round. She has treated by some oral medications, including amlodipine 2.5mg, lansoprazole 15mg for years. She showed slightly elevated value of serum uric acid about 7 mg/dL until December 2023. In January 2024, uric acid showed the elevation of 7.9 mg/dL, and then she started to take Febuxostat 20mg at minimum dose. Her general condition has been in the satisfactory level, associated with various activities as she likes.

Her physical examination showed in the following: vital signs were unremarkable for BP 138/82, pulse 68/min and SpO₂ 97%. Her statue showed height 136.7cm, weight 43.3kg, and BMI 23.2 kg/m². Consciousness, speech, and general situation were negative. Her head, face, neck, heart, lung, abdomen showed unremarkable, and neurological exams were intact. She did not complain of any particular symptoms, such as dizziness, chest oppression, or fatigue.

Biochemical Exams

Recent biochemistry exams were summarized in Table 1, in which liver, lipids and CBC were almost negative. Concerning renal function, creatinine and blood urea nitrogen (BUN, serum urea nitrogen) were in normal range. General data of biochemistry showed stable data for 7 years. Their Average Value (Av), Standard Deviation (SD) and Coefficient of Variation (CV) (ST/Av x 100) were calculated and summarized in Table 1. The results of CV showed as follows: less variation level in liver function (5.8-10.1%), similar variation level in renal function (6.4-12.9%), higher variation in Triglyceride (TG) due to meal influence, extremely low CV level in Red Blood Cell (RBC) and Hemoglobin (Hb) (2.7-3.1), and the lowest CV value in HbA1c who is not diabetic.

Table 1: The Results of Biochemistry for 2019-2025 with Statistical Analyses.

Chest X-ray showed negative result. The Electrocardiogram (ECG) findings showed Ordinary Sinus Rhythm (OSR), with unremarkable ST-T changes (Figure 1). Plethysmography has been annually performed until April 2025 [12] (Figure 2). As a result, Ankle Brachial pressure Index (ABI) values were 1.12/1.01 (right/left) associated with normal wave shapes of ECG, PCG, bilateral arms and ankles (Figure 2). Pulse wave velocity (PWV) test revealed unremarkable findings with PEP 61, ET 320, R-AI 1.15, and PEP/ET 0.19, and L (105) = L1 (54) + L2 (29) + L3 (22) [cm]. The value of Cardio-Ankle Vascular Index (CAVI) showed 8.5/8.2 (right/left), respectively in April 2025. The consecutive results of CAVI were summarized in Figure 3. During 2021-2025, bilateral CAVI data showed almost normal ranges from 7.5 to 8.6 irrespective of current age of the case as 93 years old.

Figure 1: Electrocardiogram (ECG) Findings.

Figure 2: Pulse Wave Velocity (PWV) Exam for ABI.

Figure 3: The Progress of CAVI Data for Recent Years.

Clinical Progress

This case has been stable for her symptoms, signs and several exams. For her renal aspect, uric acid (UA) have showed slight elevated value for years around 7 mg/dL. During 2022-2023, UA persisted more than 7 mg/dL, which was observed without treatment. In January, 2024, UA showed 7.9 mg/dL and then Febuxostat 10mg was started. Consequently, UA values were decreased after that as 2.2 and 4.0 mg/dL for 2024-2025. Febuxostat has been for 20mg per day, which is half amount of usual administration dose until now.

Ethical Standards

The case has complied with Declaration guideline of Helsinki [13]. This principle is accompanied by ethical regulation for clinical practice and research. This guideline was found in Ministry of Education, Culture, Sports, Science Technology (MEXT) and also Ministry of Health, Labor and Welfare (MHLW), Japan. Authors has established ethical committee in the hospital, including the president, physician, nurse, pharmacist, nutritionist, and legal professional. These members have adequate discussion for the protocol and agreed. Informed consent document was taken from the patient.

From medical point of view, current patient had hypertension and hyperuricemia. Certain relationship has been suggested between uric acid levels and the degree of arteriosclerosis for years. Arterial Stiffness (AS) was evaluated by the value of brachial-ankle Pulse Wave Velocity (baPWV) [14]. A significant linear correlation was found between them as n=205. As baPWV increased by 0.52 cm/sec, UA value increased by 1mmol/L (equals to 0.055 mg/dL) (p<0.003). The association between hyperuricemia and CVA remains in discussion. Meta-analyses were conducted from 22 studies with 770 thousand cases for evaluating several risks [15]. As a result, pooled RR was 1.42 for stroke incidence, RR 1.53 for stroke mortality. RR of stroke incidence was 1.67 for female, and 1.13 for male. Consequently, association of hyperuricemia and stroke showed higher risk in female cases.

In the light of lifestyle and psychological perspectives, the case showed some characteristics. First, the characteristics for basic daily life would be in the followings: a) she has led usually regular life for many years, including diet, exercise, and sleep; b) she grows flowers and vegetables in her home garden and then she can move around freely due to her trained lower extremities, c) her ADLs and QOL have been maintained to good degree despite her advanced age, and her communication skill for people seems to be excellent psychologically. There is a reference from a psychological perspective.?For elderly hypertensive patients with hyperuricemia, comparative study was conducted for conventional nursing care vs. novel comprehensive nursing intervention [16]. By the latter group, the results of Self-Rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) showed significant improvement comparison to the control group.

Second, clinical problems with her characteristic aspects have included the following factors. They are i) elderly case as 93 years old, ii) hypertension, iii) GERD, iv) maintained level of arteriosclerosis by pulse wave velocity (PWV), v) management for hyperuricemia, and vi) probable lower CV values of biochemistry for years. Among these, problems ii) and iii) have been stable with medication and have no particular problems. As for arteriosclerosis as iv), PWV, ABI and CAVI have been stable for five years. This seems to be rare for an elderly person over 90 years old. Possible factors include her stable basic lifestyle, mild hypertension controlled with amlodipine 2.5 mg/day, and genetic factors.

Concerning Hyperuricemia (UA) as problem v) is more common in male but less common in female. In this case, the normal to slightly elevated values of UA were observed, but medication was not administered immediately. After a period of time in the 7 mg/dL range, the blood level rose to 7.9 mg/dL, and then the minimum amount of Febuxostat 20 mg was started [17]. For its effect, UA has been decreased in satisfactory degree. No remarkable abnormalities were detected in renal function or urinary findings so far.

Third, we analyzed the data of blood chemistry 13 times over 7 years in this case. The results showed that the CV was lower than expected. The values of CV was particularly low for HbA1c 1.6%, RBC 2.7%, and Hb 3.1%. Such low fluctuations seem to be considerably lower than the level that clinicians usually feel. The reasons for this may be related to her usual regular lifestyle, stable daily blood pressure management by medication, and the absence of the consumption in alcohol, tobacco, or other luxury items. We can apply the fact that the fluctuations of RBC and Hb are limited to narrow range. Despite prohibited by the World Anti-Doping Agency (WADA), blood doping through Autologous Blood Transfusions (ABT) have been found by athletes to increase oxygen delivery [18]. In such case, the marker of Coefficient of Variation (CV) would be useful.

Certain limitation maybe exist in this article. This elderly case has stable less degree of arteriosclerosis, and stable biochemical data for long. Both factors might have any relationship for her persistent health situation for years. We will follow up her clinical course with careful attention.

In summary, 93-year-old female with stable persistence of arteriosclerosis has been presented associated with some perspectives from clinical point of view. One of the beneficial factors would be regular lifestyle with meal, exercise, sleep and beneficial communication with people. This article will hopefully become useful reference for health maintenance and progress in the light of gerontology.

Conflict of Interest: The authors declare no conflict of interest.

Funding: There was no funding received for this paper.

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