Abstract
For Aboriginal populations, as in all populations, understanding the genetic component
of cardiovascular disease informs effective treatment and prevention strategies. The
term, “genetics of cardiovascular disease,” broadly includes the genetics of susceptibility
for atherosclerosis, cardiomyopathy, arrhythmia, and congenital heart disease, collectively
a major cause of mortality and morbidity throughout the life course. Aboriginal populations
are often genetically and culturally distinct, and as would be expected with distinct
ethnic differences, there are also differences in rates and types of heart disease,
which supports the importance of understanding possible genetic factors that might
alter susceptibility. In Canada, higher rates of congenital heart malformations have
been identified in some Inuit and First Nations than in the non-Aboriginal population.
Moreover, at least 3 different First Nations communities in Canada have been found
to have disproportionately higher rates of congenital long QT syndrome, a genetic
predisposition to arrhythmia and sudden cardiac death. Although rates of ischemic
heart disease historically have been lower in Aboriginal populations, more recent
evidence suggests equal or higher rates than in non-Aboriginal populations. Although
relatively few Aboriginal communities in Canada have participated in research to explore
the genetic component of cardiovascular disease, recent progress in research standards
of practice that require collaborative approaches have opened the doors for more involvement.
Herein we present what has been learned to date through research and the apparent
gaps in the understanding of the genetics of heart disease in Canadian, American,
Circumpolar, and other international Indigenous populations.
Résumé
Dans les populations autochtones, comme dans l’ensemble des populations, la compréhension
de la composante génétique de la maladie cardiovasculaire permet d’orienter la mise
en place de stratégies de traitement et de prévention efficaces. Lorsqu’on parle de
« la génétique de la maladie cardiovasculaire », il est globalement question de la
prédisposition génétique à plusieurs affections, notamment l’athérosclérose, la cardiomyopathie,
l’arythmie et la cardiopathie congénitale. Collectivement, ces affections sont une
cause importante de mortalité et de morbidité tout au long de la vie. Les Autochtones
forment souvent des peuples distincts tant culturellement que sur le plan génétique
et, en général, les différences ethniques s’accompagnent aussi de différences quant
à la prévalence et aux types de cardiopathies, d’où l’importance de bien comprendre
les facteurs génétiques susceptibles d’influer sur les prédispositions. Au Canada,
la fréquence des malformations cardiaques congénitales s’est révélée plus élevée au
sein des populations inuites et de certaines Premières Nations que parmi la population
non autochtone. De plus, au moins trois collectivités des Premières Nations canadiennes
affichent des taux disproportionnellement élevés de syndrome du QT long congénital,
une prédisposition génétique à l’arythmie et à la mort subite d’origine cardiaque.
Bien que la fréquence de cardiopathie ischémique ait été dans le passé inférieure
à la norme au sein des populations autochtones, de récentes données montrent qu’elle
est maintenant égale ou supérieure à celle observée parmi les populations non autochtones.
Relativement peu de groupes autochtones du Canada ont participé à des études visant
à explorer la composante génétique de la maladie cardiovasculaire, mais des modifications
récemment apportées aux normes de pratique en recherche, mettant de l’avant des approches
de collaboration, ont ouvert la porte à une plus grande participation. Nous présentons
ici un bilan des connaissances acquises jusqu’ici grâce à la recherche et décrivons
les lacunes apparentes dans notre compréhension de la génétique de la cardiopathie
propre aux peuples autochtones du Canada, de l’Amérique et de la région circumpolaire
ainsi qu’aux populations indigènes d’autres pays.
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Article info
Publication history
Published online: July 11, 2015
Accepted:
July 9,
2015
Received:
May 13,
2015
Footnotes
See page 1110 for disclosure information.
Identification
Copyright
© 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
