In DbCM, there are other contributors in addition to cardiac hypertrophy such as insulin resistance, HG in the milieu, and oxidative stress-activating cardiac hypertrophic genes, such as β-myosin heavy chain (ß-MHC), atrial natriuretic factor (ANP), and brain natriuretic factor (BNP) (29). Here, NPPA is linked to cardiac hypertrophy.