INS and obesity due to melanocortin 4 receptor deficiency: The mechanisms underlying the obesity-, insulin resistance-, and/or hyperinsulinemia-induced vascular disease are not fully understood but might include hemodynamic factors such as hypertension, activation of the renin-angiotensin-aldosterone system, metabolic factors such as insulin and advanced glycation end products, and other factors such as adipokines, inflammation, or oxidative stress [41].