These findings could be explained as the decreased CTRP9 levels in females suffering from T2D with or without CAD suggested that like APN in the absence of insulin, CTRP9 had little effect in suppressing gluconeogenesis [22], in contrast to CTRP3, which acted independently off insulin levels.[19] Moreover, the state of chronic low grade inflammation associated with increased dyslipidemia resulted in decreased levels of APN [23], consequently reducing the secretion of CTRP9 as it requires APN for its production [24]. This evidence concerns the gene ANPEP and metabolic syndrome.