INS and obesity due to melanocortin 4 receptor deficiency: The literature reports that the insulin resistance induced by obesity with associated hyperinsulinemia could promote cardiac remodeling via the growth-promoting properties of insulin or by attenuating the anti-apoptotic signaling of the phosphatidylinositol 3′-kinase (PI3K)-Akt (protein kinase B [PKB]) pathway elicited by insulin receptor activation [46,48].