Cardiovascular and renal disease are highly prevalent in Canada's Aboriginal population even though rates of cardiovascular disease are falling in the rest of the country. High and rising prevalence rates of diabetes must be addressed to impact significantly on global cardiovascular and renal risk. Type 2 diabetes is occurring in Aboriginal youth, putting them at greater risk of long-term complications. The reasons for the sudden upswing in diabetes rates in the past 60 years are a result in large part to social determinants of health, which for Aboriginal people include the multigenerational effects of colonization and consequences of the residential school system. Addressing cardiovascular and renal risk therefore requires the knowledge and skills to implement clinical practice guideline-based interventions, the ability to create culturally safe chronic disease management programs in partnership with Aboriginal communities, and advocacy across sectors for improvements in the social determinants of health.