Genes and environment in type 2 diabetes and atherosclerosis in aboriginal Canadians

The incidence of coronary heart disease (CHD) among aboriginal people in northern Ontario has tripled over the past 20 years. This is inextricably linked to the remarkably high prevalence of type 2 diabetes in these native communities. Approximately 40% of the Oji-Cree of northern Ontario have typical obesity-related type 2 diabetes, which represents a drastic increase from virtually unreportable levels 50 years ago. The Oji-Cree have a private mutation in the HNF1A gene, namely G319S, which is absent from other ethnic groups and aboriginal populations. The most compelling reasons that HNF1A S319 is a diabetes-susceptibility allele are its consistent statistical association with the presence and severity of diabetes. Also, HNF1A S319 has specificity and positive predictive values of 97% and 95%, respectively, for the development of diabetes in the Oji-Cree by 50 years of age. This makes the HNF1A G319S genotype the most specific predictive genetic test for diabetes in any human population. HNF1A S319 has all the attributes of a thrifty allele in the Oji-Cree. It is possible that the recent increase in CHD in the aboriginal people of northern Ontario is the result of the expression of diabetes susceptibility due to HNF1A S319 as a consequence of rapid changes in environment and lifestyle.