INS and obesity due to melanocortin 4 receptor deficiency: Some of the described mechanisms of obesity associated with CVD are related to hemodynamic alterations that make the subjects predisposed to changes in cardiac morphology and ventricular dysfunction and hypertrophy, neurohormonal and metabolic abnormalities, such as increased sympathetic nervous system tone, activation of the renin–angiotensin–aldosterone system, insulin resistance with hyperinsulinemia, leptin resistance with hyperleptinemia, adiponectin deficiency, lipotoxicity and lipoapoptosis.