Research and cardiopulmonary disease in Down syndrome: opportunities for therapeutic leverage. Research and cardiopulmonary disease in Down syndrome: opportunities for therapeutic leverage. A number of Hsa21-encoded genes affect organ homeostasis. Persons with Down syndrome have low rates of cardiovascular disease (CVD), despite elevated risk factors. In contrast, congenital heart disease (CHD) is highly prevalent in Down syndrome. Pulmonary infectious disease is the leading cause of mortality in Down syndrome, caused by both intrinsic (morphological factors) and extrinsic (immune dysfunction) factors. Listed in each organ cartoon are genes implicated in disturbed heart, lung and immune function. Research into the mechanisms of resistance to development of coronary artery disease and solid tumours inherent in persons with Down syndrome will undoubtedly benefit the larger population (i.e. therapeutic leverage). MI/CAD: myocardial infarction/coronary artery disease; AVSD: atrioventricular septal defect; RSV: respiratory syncytial virus. Kelley L. Colvin, and Michael E. Yeager Eur Respir Rev 2017;26:160098 ©2017 by European Respiratory Society