IGFBP7 and diabetes mellitus: At the transcription level, DM can lead to diastolic dysfunction by its action on cellular proliferation through interaction between insulin-like growth factors (IGFs) and growth hormones (GH) [13]. The RELAX trial studied the relationship between insulin-like growth factor-binding protein-7 (IGFBP7) and HFpEF, the result of the study concluded that higher baseline IGFBP7 was moderately correlated to worsening diastolic cardiac function with E velocity, higher left atrial volume index and elevated right ventricular systolic pressure [13].