Cardiovascular disease (CVD) and diabetes are a major health burden for indigenous Australians and account for 31% of years of life lost (AIHW 2003). Non-communicable diseases contribute ¾ of the gap in life expectancy between indigenous and non-indigenous Australians and of this over ½ is directly attributable to cardiovascular disease and diabetes (Zhao and Dempsey, MJA 2006).

Unfortunately the trends are towards worsening from not only heart, stroke and vascular disease but also renal failure and blindness.

The underlying causes are both complex and multiple, it is unhelpful either to consider this solely from a medical perspective or solely as a consequence of changes inflicted on the communities through dispossession, disharmony, poverty and other socio-cultural changes. These are all important and need to be addressed. From a scientific perspective causal factors proposed range from those with an anthropological base (Thrifty Gene), social and cultural influences arising from disadvantage, biological factors, particularly the classical cardiovascular risk factors, early life events and epigenetics or health system failure and access. It is important to better understand the relative contributions to define the best targets for improvement. This requires simultaneous discovery, evaluation and implementation. Nowhere in the health system should the cycle between discovery and evidence based implementation be shorter. Much of this research will be at the translational and health services end but there is also a huge potential in a better understanding of the underlying mechanisms, particularly early life events and the probable role of epigenetic changes influencing gene function to the detriment of the cardiovascular and metabolic health of young and middle aged adults.