INS and pulmonary arterial hypertension: Therefore, in obese individuals, epicardial adipose tissue and ectopic lipiddisposition in cardiomyocytes may contribute to the development of aninflammatory and insulin-resistant microenvironment in close proximity to theright ventricle and pulmonary circulation that has powerful physiologicaleffects resulting in the development and progression of PAH and contributing toa dysfunctional right ventricle.