“Preventive measures are often neglected because they don’t generate revenue, but they are incredibly important,” Leslie Cho, MD, director of Cleveland Clinic’s Women’s Cardiovascular Center, told Becker’s. “They benefit society and improve healthcare overall.”
Dr. Cho — who also is chief quality officer of the health system’s Robert and Suzanne Tomsich department of cardiovascular medicine and section head of preventive cardiology and rehabilitation — shared her insights on the American Heart Association’s 2025 Heart Disease and Stroke Statistics report with Becker’s, including what leaders need to know.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What was your initial reaction to the report? Did any of the statistics surprise or stick out to you?
Dr. Leslie Cho: If you look at the numbers, it’s horrifying how much hypertension in pregnancy has increased. It’s doubled. I’m an interventional cardiologist specializing in women’s heart disease. I’m also the chair of the American College of Cardiology’s Cardiovascular Disease in Women Committee. For me, I wasn’t shocked to see the data. We’ve been talking about it. But the sheer rise in that number was very startling, and it really should be a call to action.
I fear that this will be one of those statistics that gets overlooked in many of these discussions, but it’s incredibly important. There’s a huge opportunity for hospital leaders to invest in prevention for this group and make a significant impact. Hypertension during pregnancy not only increases the risk of heart disease but also raises the likelihood of developing hypertension later in life.
You can really change the trajectory of a woman’s life by intervening early. Not only that, women actually dictate healthcare decisions for most families. By teaching women healthy habits, they can have a dramatic impact on their family’s health as well.
If you have hypertension during pregnancy at Cleveland Clinic, we refer you either to the preventive cardiology clinic or to a specialized cardio-OB clinic. We don’t start those patients on medication right away; we teach them about lifestyle habits and dietary modifications so they can prevent heart disease and hypertension later in life.
Q: Why is it important for hospital and health system leaders to prioritize prevention?
LC: Preventive care, especially for secondary prevention, is absolutely crucial. Electronic health records make implementing a system to prioritize prevention is easier than ever. There are so many ways we can make prevention front and center for every single patient.
These kinds of statistics bring us back to facts. People can have their opinions, but facts are facts. The data is clear: Lowering cholesterol, improving diet and nutrition and taking a preventative approach work.
Part of the problem is that cardiology is a very procedure-driven specialty. The work we do, especially with valve procedures, is heavily focused on interventions. Percutaneous options are making lifesaving and quality-of-life-improving procedures more accessible to more people, but they come at an increased cost.
The frustrating part is that preventive measures are the cheapest interventions we have. One of the least expensive yet most effective resources is a nutrition consult, which costs about $50 to $75 and is only covered by insurance if you have diabetes. It would be great if they could cover nutrition counseling for every patient, but they don’t. Insurance companies would rather pay for a stress test or a stent than a nutrition consult.
This is something we’re going to struggle with even more in the future. As a society, we need to have serious, thoughtful discussions about these extremely expensive procedures and what makes sense.
Q: What role can hospital leaders play in advancing initiatives that address risk factors for heart disease and stroke?
LC: For hospital systems, preventing readmissions — which is the big buzzword now — can be a major focus. Nobody wants readmissions.
We used to have one of the lowest referral rates for cardiac rehabilitation at Cleveland Clinic until we made a dedicated, conscious decision to improve in this area.
Now every single patient who comes into our system with a heart attack, stroke, bypass surgery or stent placement automatically receives a cardiac rehabilitation referral, and we have one of the highest referral rates.
Cardiac rehab, which is something insurance companies cover, has been a strong, enterprise-wide initiative for us.
Q: Do you foresee the adoption of GLP-1s having an effect on heart disease and stroke statistics in the future?
LC: I do think they are an amazing advancement and I believe obesity is a chronic disease, we’re one of the biggest users of GLP-1 receptor agonists. But here’s what we’ve learned about GLP-1 receptor agonists, once people start these medications, most never get off them.
We’re able to get about 15% of people off the medication, but the other 85%? Never. We lower the dose and they gain the weight back. Unless we teach people about diet and exercise, that’s not going to change.
It’s an interesting phenomenon: Insurance companies don’t want to pay for a nutrition visit, but they’ll pay for a GLP-1 receptor agonist.
The people who successfully stop taking these medications are the ones who have learned how to integrate diet and exercise into their lives and make it part of their core habits.
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