Since high levels of ubiquitination and 4-HNE are reported to induce cardiac hypertrophy, cellular damage and apoptosis in the heart [61–66], the significantly elevated levels of 4-HNE modified proteins along with ubiquitination that we found after HIES in Nrf2-null animals may result in pathological atrial hypertrophy. Here, NFE2L2 is linked to cardiac hypertrophy.