Chemotherapy for childhood cancer can lead to heart problems decades down the road, but researchers are exploring ways to reduce the risk.

Eric Chow, MD, MPH, of Fred Hutchinson Cancer Research Center in Seattle, and colleagues analyzed data from five randomized studies of children with cancer who were treated with the cardiotoxic drug doxorubicin with or without Zinecard (dexrazoxane), a chelating agent that protects the heart. After nearly 18 years since their cancer diagnosis, those who used Zinecard along with doxorubicin had better heart function and lower levels of biomarkers associated with heart damage.

Chow’s team also analyzed more than 500 participants in the long-running Childhood Cancer Survivor Study. More than a quarter had evidence of undiagnosed high blood pressure or prediabetes, while 17% had abnormal cholesterol—all risk factors for cardiovascular disease. What’s more, up to half of those who had been diagnosed with these conditions were not adequately treated.

In a new trial, the researchers will evaluate whether childhood cancer survivors can benefit from participating in a telehealth counseling session with Fred Hutch experts to develop a plan for managing their cardiovascular risk.