LEP and obesity due to melanocortin 4 receptor deficiency: As an active endocrine and paracrine organ, excessive adipose tissue releases multiple hormonses and cytokines, such as leptin, adiponectin, IL-6, and TNF-α, which result in diabetes, cardiovascular inflammation, increased blood pressure level, fibrinolysis, and atherosclerosis.187–189 Accordingly, physical activity can attenuate the adverse effects of obesity on CVD events.190