Kyuwan Lee

Date of Graduation


Document Type


Degree Type



School of Medicine


Physiology, Pharmacology & Neuroscience

Committee Chair

Paul Chantler

Committee Co-Chair

Randy Bryner

Committee Member

Mark Olfert


Background: The overall rate of cardiovascular diseases (CVD) mortality has decreased in the US over the last few years. However, in rural areas, this reduction in CVD mortality is less substantial compared to urban areas despite the effort to translate lifestyle intervention which was successful in urban areas. An effective approach to translating a lifestyle intervention into a rural setting would be to consider their rural characteristics, resources, and to engage the local community directly. This may be accomplished by using community-based participatory research (CBPR), which is an approach that involves equitable partnerships between researchers and community stakeholders.;Aims: Aim 1: Use CBPR principles to conduct a pilot study to test the feasibility and acceptability of a rural multicomponent lifestyle intervention in CVD patients and their partners. We will determine feasibility by examining study participant recruitment and retention, implementation fidelity, and acceptability by assessing provider and patient satisfaction. Aim 2: Examine the effect of CBPR-developed lifestyle intervention on CV health and other traditional CVD risk factors in rural populations. We hypothesize the pulse wave velocity and endothelial function will be enhanced with improved Framingham risk score and 6-min walk distance after 10 weeks of intervention.;Methods: We assessed the feasibility and acceptability using satisfaction questionnaires, retention and recruitment rate along with cardiovascular parameters i.e., Framingham risk score, 6-min walk test, reactive hyperemia index, carotid thickness, and pulse wave velocity, pre and post 10 week lifestyle intervention.;Results: 10 patients with CVD were screened with their family member, yielding 20 individuals screened (recruitment rate 59%). 17 patients were enrolled and retained (retention rate 100%). The 6-minute walk distance significantly (p=0.01) increased (466+/-17m to 503+/-17m) with a tendency of improved heart rates and diastolic function represented by sub-endocardial viability ratio after 10 weeks intervention, although these parameters did not quite reach statistical significance. In contrast, there were no significant changes in the other CVD parameters. These findings provide valuable evidence to conduct lifestyle intervention for CVD patients in rural areas.;Conclusion: This study suggests that the multi-lifestyle intervention using the principle of CBPR is feasible and acceptable to improve CV health in rural CVD populations. Because this study was conducted as a pilot study which consists of smaller populations and shorter periods than the full intervention, we expect that phase 2 will show more significant outcomes which determine if an educational lifestyle intervention is beneficial to reduce the incidence of CVD in rural areas. These findings will also provide an important evidence to implement a larger trial targeted at CVD patients and their family member.

Available for download on Tuesday, December 31, 2120