However, several mechanisms have been proposed to explain LV dysfunction induced by hypercholesterolemia: (1) increased cardiac oxidative stress [24], (2) alteration of the myocardial energy metabolism [22], (3) changes in myosin heavy-chain isoform expression patterns [4], (4) down-regulation and redistribution of connexin-43 expression in myocardium [25], and (5) impaired activation of myocardial adenosine triphosphate-sensitive potassium channels [19]. The gene discussed is GJA1; the disease is familial hypercholesterolemia.