Endothelial dysfunction has been found prior to any signs of atherosclerotic plaque formation in patients with a variety of risk factors for atherosclerosis. Elevated serum cholesterol has repeatedly been associated with endothelial dysfunction as demonstrated by impaired vasoreactivity to vasodilating stimuli.

The aim of this research was to determine whether short term lowering of serum cholesterol levels by life style changes or by cholesterol lowering medication could reverse or reduce the endothelial dysfunction. The brachial artery diameter was measured by high-resolution ultrasound at rest and during reactive hyperemia pre and postintervention. Fifty-three subjects with cholesterol levels above 240 mg/dl were randomly assigned to three groups: Lifestyle change (n=17), medication (n=17), and placebo (n=19).

All individuals were assessed for readiness to change using Prochaska’s and DiClemente’s stages of change. All individuals were the highest in contemplation stage at the beginning of the intervention. Only individuals in the lifestyle group moved to the action stage of change after intervention. There was no change in the individuals’ reported mood state pre and post-intervention.

No correlation was seen between the lipid values and the brachial artery diameter change following the six week intervention period for any of the groups and groups did not differ on reactivity to vasodilating stimuli pre or post intervention. There was a statistically significant drop in both the total cholesterol and LDL-cholesterol in the lifestyle and medication groups, but no change in the HDL-cholesterol in all three groups. This contradicts previous research showing that HDL-cholesterol levels decrease with low fat diet.


School of Public Health

First Advisor

Glen G. Blix

Second Advisor

Jerry W. Lee

Third Advisor

Gier Frivold

Degree Name

Doctor of Public Health (DrPH)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Vasodilation -- physiology; Endothelial Growth Factors; Lipoproteins, LDL Cholesterol; Coronary Arteriosclerosis -- physiopathology; Cholesterol.



Page Count

x; 99

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives