Another pathway involved in cardiac hypertrophy is mediated through increased activation of IGF-Akt pathway (Yan et al., 2019) (Figure 3: Schematic representation of molecular mechanism of Sirt6 in various diseases), which was shown in Sirt6 deficient mice (Sundaresan et al., 2012; Vitiello et al., 2017). The gene discussed is IGF1; the disease is cardiac hypertrophy.